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MENTAL   DEFECTIVES 

BARR 


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MENTAL  DEFECTIVES 


THEIR 


HISTORY,  TREATMENT  AND  TRAINING 


MARTIN  W.  BARR,  M.  D. 

CHIEF  PHYSICIAN  PENNSYLVANIA  TRAINING  SCHOOL  FOR  FEEBLE-MINDED 
CHILDREN,  ELWYN,  PA. 


ILLUSTRATED  BY  53  FULL-PAGE   PLATES 


PHILADELPHIA 

P.  BLAKISTON'S   SON   &  CO. 

1012  WALNUT   STREET 


FOREWORD. 


The  studies  herein  presented — several  of  which  have  appeared 
from  time  to  time  in  various  journals — have  been  written  in  response 
to  many  inquiries  that  have  come  to  me  regarding  mental  defectives. 

The  result  of  an  experience  of  almost  twenty  years  in  carrying 
forward  principles  of  treatment  and  of  training,  tested,  proven  and 
denned — it  addresses  itself  primarily  to  anxious  parents  and  to  earnest 
teachers,  rather  than  to  the  scientist.  No  effort  has  been  spared  to 
render  the  statistics  accurate,  and  the  statements  trustworthy,  all 
doubtful  data  having  been  unhesitatingly  discarded.  In  endeavor- 
ing to  emphasize  the  utter  hopelessness  of  cure,  and  also  the  needless 
waste  of  energy  in  attempting  to  teach  an  idiot,  I  have  sought  to 
make  clear  the  possibilities  that  may  be  attained  in  the  training  of 
the  imbecile,  the  urgent  need  of  preventing  the  backward  child  from 
degenerating  into  imbecility,  and  of  safeguarding  the  absolutely  irre- 
sponsible ammoral  imbecile  from  crime  and  its  penalty. 

Some  subjects  I  have  not  touched  upon  at  all  for  obvious  reasons, 
nor  have  I  dwelt  at  any  length  upon  the  stigmata  of  degeneration. 
Sexual  inversion  is  not  a  subject  to  present  to  the  general  reader,  and 
researches  into  both  the  psychology  and  pathology  of  idiocy  have 
yet  to  gather  sufficient  data  upon  which  to  base  dogmatic  opinion. 

My  acknowledgments  are  due  to  my  immediate  associates  as  well 
as  to  many  colaborers  in  the  work  at  large,  whose  experience  has 
aided  me  in  substantiating  theories,  in  working  out  basic  principles, 
and  in  verifying  conclusions.  In  this  last  my  three  "  boys  "  have 
materially  contributed,  in  addition  to  the  aid  gladly  and  efficiently 
rendered  in  the  preparation  of  the  book;  many  of  the  photographs 
by  Jake,  the  translations  by  Arthur,  and  the  entire  typewriting  of  the 
manuscript  by  Judson,  all  being  an  exposition  of  the  main  argument 
— the  possibilities  to  be  attained  through  training. 

Martin  W.  Barr. 

Pennsylvania    Training    School   for    Feeble-Minded    Children,    Elwyn, 
Pa.,  August  i,  1904. 


TABLE  OF  CONTENTS. 

Chapter.  Page. 

I.  Synonyms  and  Definitions 17 

II.  History 24 

III.  Classification  78 

IV.  Etiology  91 

V.  Diagnosis  ;  Prognosis  ;  Death  Periods 1 24 

VI.  Training  and  Treatment 133 

VII.  Craniectomy;  Asexualization 182 

VIII.  Cretinism  and  Myxcedema 198 

IX.  Microcephalia  and  Hydrocephalus 204 

X.  Epilepsy    ,.211 

XL  Idiots  Savants;  Insanity 228 

XII.  Echolalia  233 

XIII.  Adenoma  Sebaceum 243 

XIV.  Illustrative  Cases. 

Profound  Apathetic  Unimprovable  Idiots ;  Profound 
Excitable  Unimprovable  Idiots ;  Superficial,  Apa- 
thetic Improvable  Idiots ;  Superficial,  Excitable  Im- 
provable Idiots  ;  Idio-Imbeciles 249 

XV.  Illustrative  Cases   (continued). 

Imbeciles:    Low-Grade;  Middle-Grade;  High-Grade.  256 
XVI.  Illustrative  Cases   (continued). 

Moral  Imbeciles:  Low -Grade;  Middle-Grade;  High- 
grade  264 

XVII.  Illustrative  Cases   (continued). 

Backward  Children ;  Imbeciles  by  Deprivation ; 
Negroid  Type;  American  Indian  Type;   Mongolian 

Type   282 

XVIII.  Illustrative  Cases   (continued). 

Craniectomy ;  Cretinoids ;  Myxcedema  ;  Microceph- 
alia ;  Hydrocephalus ;  Idiots  Savants ;  Insanity 290 

ix 


X  CONTENTS. 

XIX.  Illustrative  Cases  (concluded). 

Epilepsy :      Grand     Mai ;     Petit    Mai ;    Jacksonian ; 

Psychic   309 

XX.  The  Case  of  Samuel  Henderson,  Murderer  :    Re- 
sponsible or  Irresponsible? 314 

XXI.  Stories  of  the  Children 327 

Bibliography   338 

Index 348 


MENTAL  DEFECTIVES. 


CHAPTER   I. 

synonyms  and  definitions. 

Synonyms. 

Through  all  ages,  in  many  climes,  we  may  trace  the  close  analogy 
in  many  tongues,  of  the  various  titles  of  mental  defect,  thus : 

Greek. — Iditas;  idios. 

Latin. — Amentia;  fatuitas;  imbecillitas. 

Italian. — Idiotismo ;  tardivi. 

Spanish. — Idiota;  idiotismo;  tardo. 

Portugese. — Idiota ;  idiotismo ;  imbecilidade ;  imbecil ;  tardo. 

French. — Idiote;   imbecile;  les  enfants  du  bon  Dieu;   les  enfants 
arrieres;  demence  innee;  idiotisme;  beganne  (Island  of  Jersey). 

German. — Geistig  zuriick  gebliebene ;  congenitale  oder  angeborener 
Blodsinn  und  Dummheit;  die  Spracheigenheit. 

Scandinavian. — Aandelig  abnorme;  sinueslo;  idiot. 

Japanese. — Hakuchi. 

Scotch. — The  daft  bairn;  the  innocent;  the  feckless. 

English. — Idiot;  imbecile;  backward;  feebly-gifted. 

American. — Idiot;    imbecile;    backward;    feebly-gifted;    feeble- 
minded. 

Definitions. 

The  terms  idiot  and  imbecile  indiscriminately  applied  for  cen- 
turies to  a  despised  and  neglected  class,  have  naturally,  through  the 
mere  force  of  association,  become  synonymous  with  and  even  ex- 
pressive of  opprobrium  and  reproach.  So  closely  welded  has  been 
this  association  of  word  and  idea,  that  even  the  advance  of  the  nine- 
teenth century  with  all  its  revelation  of  true  conditions  has  failed  to 
sunder  them.  Viewed  apart  from  this  association  the  expressions 
idiot  and  imbecile  really  do  indicate  certain  conditions  now,  as  clearly 
2  17 


1 8  SYNONYMS   AND   DEFINITIONS. 

as  did  the  words  in  the  original  languages  from  which  they  are  de- 
rived, as  may  be  easily  seen  by  comparison. 

The  word  idiot  is  derived  from  the  Greek  cdccozyi;,  "  a  private 
person,"  or  Wcoq,  "  peculiar  " — i.  e.,  a  person  devoid  of  understand- 
ing from  birth — incapable  of  holding  communication  with  another, 
therefore  set  apart — alone. 

The  term  imbecile  is  taken  from  the  Latin  imbecillis — in  and 
bacillum,  as  "  needing  a  staff  " ;  or  in  vacillo,  "  tottering,"  "  wanting 
strength  of  mind,"  "  weak  and  feeble  " ;  expressive  of  a  certain  de- 
gree of  intelligence,  but  unstable,  incapable,  irresponsible. 

The  idiot  intelligently  sees  nothing,  feels  nothing,  hears  nothing, 
does  nothing,  and  knows  nothing.  He  simply  lives  alone — the  soli- 
tary one. 

The  imbecile,  on  the  other  hand,  is  able  to  see,  to  understand,  and 
to  discriminate  in  greater  or  less  degree. 

Another  phase  of  mental  defect  either  previously  unrecognized  or 
else  belonging  specifically  to  a  later  period  has  developed  the  term 
"  Backward-child  " — one  unable  to  advance  rapidly.  The  differences 
we  note,  are  of  degree  not  of  kind.  In  reality  from  the  idiot,  through 
the  various  grades  of  imbecility,  up  to  the  backward  and  the  feebly- 
gifted  there  is  a  regular  ascending  scale  ever-lessening  of  mental 
defect. 

In  America  the  tendency  to  draw  away  from  those  terms  which, 
however  correct  in  derivation  and  signification  yet  preempted  and 
warped  through  long  usage,  fail  to  convey  the  exact  idea  apart  from 
one  of  contumely,  has  resulted  in  the  adoption  of  the  expression 
"  feeble-minded,"  covering  every  form  of  mental  defect ;  and  of 
"backward"  and  "feebly-gifted,"  for  the  lesser  phases.  This  for 
general  purposes  is  more  in  accord  with  popular  sentiment,  although 
for  practical  purposes  and  in  scientific  classification,  the  older  and 
more  precise  terms  are  still  adhered  to. 

Again  the  terms  idiocy  and  imbecility  are  often  erroneously  con- 
sidered synonymous  with  insanity.  It  is  true  that  certain  conditions 
of  idiocy  and  imbecility  do  resemble  that  phase  of  insanity  known  as 
dementia — a  reversion  to  the  original  mental  state  of  childhood — in 
reality  a  form  of  second  childhood.  But  the  states  are  not  identical, 
although  one  may  lapse  into  the  other.     One  is  defect,  the  other 


DEFINITIONS.  1 9 

disease;  the  imbecile  in  the  former  being  the  counterpart  of  the  de- 
ment in  the  latter,  just  as  the  moral  imbecile  is  the  analogue  of  the 
paranoiac. 

Ireland  says :  "  Dementia  begins  with  average  intelligence  which 
gradually  diminishes ;  idiocy  begins  with  a  low  amount  of  intelligence, 
which  gradually  increases."  Spitzka  says :  "  Imbecility  is  a  defi- 
ciency of  the  brain,  with  permanent  impairment  of  the  intellectual 
faculties,"  whereas  "  Insanity  is  a  mental  condition,  the  result  of 
brain  disease,  affecting  the  integrity  of  the  mind,  characterized  by 
intellectual  or  emotional  disorder." 

According  to  the  old  Roman  law,  mental  defectives  were  desig- 
nated "  mente  capti,"  or  those  deficient  in  intellect. 

Lord  Coke's  definition  is :  "  An  idiot  is  one  who  from  his  nativity, 
by  perpetual  infirmity,  is  non  compos  mentis." 

Blackstone  says :  "  An  idiot,  or  natural  fool,  is  one  that  hath  no 
understanding  from  his  nativity,  and  therefore  is  by  law  presumed 
never  likely  to  attain  any." 

Another  legal  definition  is  the  following :  "  He  that  shall  be  said  to 
be  a  sot  and  idiot  from  his  birth,  is  such  a  person  who  cannot  count 
or  number  twenty  pence,  nor  tell  who  was  his  father  or  mother, 
nor  how  old  he  is,  so  as  it  may  appear  that  he  hath  no  understanding 
or  reason  what  shall  be  for  his  profit  or  what  for  his  loss ;  but,  if  he 
have  sufficient  understanding  to  know  and  understand  his  letters,  and 
to  read  by  teaching  or  information,  then  it  seems  he  is  not  an  idiot." 

Shakespeare  speaks  of  him  as :  "  One  who  holds  his  bauble  for  his 
God  " ;  and,  again :  "  One  who  tells  a  tale  full  of  sound  and  fury, 
signifying  nothing." 

Esquirol  was  the  first  medical  writer  who  clearly  defined  the  term 
idiocy,  and  he  restricted  its  use  to  congenital  mental  defect.  He 
says :  "  Idiocy  is  not  a  disease,  but  a  condition  in  which  the  intellec- 
tual faculties  are  never  manifested;  or  have  never  been  developed 
sufficiently  to  enable  the  idiot  to  acquire  such  an  amount  of  knowl- 
edge as  persons  of  his  own  age,  and  placed  in  similar  circumstances 
with  himself,  are  capable  of  receiving.  Idiocy  commences  with  life, 
or  at  that  age  which  precedes  the  development  of  the  intellectual  and 
effective  faculties,  which  are  from  the  first  what  they  are  doomed  to 
be  during  the  whole  period  of  existence."     He  observes  further: 


20  SYNONYMS    AND   DEFINITIONS. 

"  Dementia  and  idiocy  differ  essentially.  ...  A  man  in  a  state  of 
dementia  is  deprived  of  advantages  which  he  formerly  enjoyed.  He 
was  a  rich  man,  who  has  become  poor.  The  idiot,  on  the  contrary, 
has  always  been  in  a  state  of  want  and  misery."  (L'homme  en 
demence  est  prive  des  biens  dont  il  jonissait  autrefois,  c'est  un  riche 
devenit  pauvre.    L 'idiot  a  toujours  ete  dans  I'infortune  et  la  misere.) 

Seguin,  in  speaking  of  the  idiot,  says :  "  That  the  will  sits,  like  the 
lady  in  Comus,  locked  up  in  alabaster."  He  defines  idiocy  as :  "A 
specific  infirmity  of  the  craniospinal  axis,  produced  by  deficiency  of 
nutrition  in  utero  and  in  neo-nati." 

Dr.  Howe  says :  "  Without  pretending  to  any  scientific  accuracy, 
idiocy  may  be  defined  to  be  that  condition  of  a  human  being  in  which, 
from  some  morbid  cause  in  the  bodily  organization,  the  faculties  and 
sentiments  remain  dormant  or  undeveloped,  so  that  the  person  is  in- 
capable of  self-guidance  and  of  approaching  that  degree  of  knowl- 
edge usual  with  others  of  his  age. 

"  There  are  different  degrees  of  idiocy.  There  is  the  absolute  idiot 
— the  unfortunate  creature  who  has  hearing,  but  seems  not  to 
hear;  sight,  but  seems  not  to  see;  who  never  learns  to  talk;  who 
cannot  put  on  his  own  clothes  or  feed  himself  or  do  the  simplest 
thing." 

"  There  is  the  imbecile  who  cannot  take  care  of  himself  at  all,  but 
can  do  pretty  well  under  the  direction  of  others.  There  is  the 
simpleton  who  thinks  he  is  a  man,  and  who  hangs  on  the  skirts  of 
society,  the  victim  of  some  and  the  butt  of  others.  ...  It  may  be 
supposed,  from  the  tenor  of  our  remarks,  that  we  are  not  much  dis- 
posed to  draw  any  sharp  line  of  distinction  between  idiots  and  other 
human  beings,  and  still  less  disposed  to  deny  them  the  attributes  of 
humanity,  and  sink  them  to  a  level  with  the  brutes.  .  .  .  We  main- 
tain that  they  have  the  germs  of  human  faculties  and  sentiments, 
which  in  most  cases  may  be  developed.  Indeed,  the  number  of  per- 
sons left  by  any  society  in  a  state  of  idiocy,  is  one  test  of  the  degree 
of  advancement  of  that  society  in  true  and  Christian  civilization. 
Precise  unexceptionable  definitions  are  exceedingly  difficult.  But  we 
must,  at  any  rate,  regard  idiocy  and  imbecility  as  a  condition  varying 
in  degree,  rather  than  a  disease,  and  it  is  concomitant  of  defective 
physical  organization." 


Plate  I. 


ECHOLALIA. 


DEFINITIONS.  21 

Again  Howe  defines  mental  defectives  as :  "  Pure  idiots,  fools  and 
simpletons,  or  imbeciles  as  they  are  sometimes  called."  He  goes  on 
to  say :  "  If  a  boy  at  ten  or  twelve  years  of  age  (or  even  six  or 
eight)  hears,  and  does  not  speak,  it  is  prima  facie  evidence  that  his 
intellect  is  in  an  undeveloped  state.  It  furnishes  a  strong  probability 
of  idiocy." 

"  If  he  can  merely  use  nouns, — the  names  of  things, — he  is  prob- 
ably foolish." 

"  If  he  can  construct  and  understand  simple  sentences,  but  cannot 
use  or  apprehend  involved  and  complicated  ones,  he  is  merely  a 
simpleton." 

"  The  ability  to  use  polysyllables  would  not  raise  him  above  the 
second  grade.  In  using  the  name  of  a  person  or  thing  the  number 
of  syllables  does  not  add  much  to  the  complexity  of  thought  or  diffi- 
culty of  utterance." 

"  A  better  test  is  the  substitution  of  pronouns  for  nouns.  A  little 
child,  or  a  fool,  would  say,  for  instance,  '  Willie  want  water,'  while 
a  simpleton  would  say,  '  I  want  water.' " 

"  A  simpleton  can  hardly  make  a  complicated  sentence,  such  as 
the  following :  '  Should  it  be  fair  to-morrow,  and  my  father  consent, 
I  will  either  come  to  see  you,  or  send  my  brother.'  The  use  of  the 
conjunction  disjunctive  is  always  difficult  for  persons  of  feeble  mental 
organization." 

"Idiots  of  the  lowest  class  are  mere  organisms,  masses  of  flesh 
and  bone  in  human  shape,  in  which  the  brain  and  nervous  system  has 
no  command  over  the  system  of  voluntary  muscles ;  and  which  conse- 
quently are  without  power  of  locomotion,  without  speech,  without 
any  manifestation  of  intellectual  or  affective  faculties." 

"  Fools  are  a  higher  class  of  idiots,  in  whom  the  brain  and  nervous 
system  are  so  far  developed  as  to  give  partial  command  of  the 
voluntary  muscles ;  who  have  consequently  considerable  power  of 
locomotion  and  animal  action;  partial  development  of  the  affective 
and  intellectual  faculties,  but  only  the  faintest  glimmer  of  reason,  and 
very  imperfect  speech." 

"  Simpletons  are  the  highest  class  of  idiots,  in  whom  the  harmony 
between  the  nervous  and  muscular  system  is  nearly  perfect;  who 
consequently  have  normal  powers  of  locomotion  and  animal  action; 


22  SYNONYMS    AND   DEFINITIONS. 

considerable  activity  of  the  perceptive  and  affective  faculties;  and 
reason  enough  for  their  simple  individual  guidance,  but  not  enough 
for  their  social  relations." 

Other  definitions  read  thus : 

"  Idiocy  is  the  want  of  a  natural  or  harmonious  development  of 
the  mental,  active  and  moral  powers  of  a  human  being,  and  usually 
dependent  upon  some  defect  or  infirmity  of  his  nervous  organiza- 
tion."    Wilbur. 

"  Idiocy  is  that  condition  of  the  mind,  in  which  the  reflective,  and 
all,  or  part,  of  the  affective  powers,  are  either  entirely  wanting,  or 
are  manifested  to  the  slightest  possible  extent."     Ray. 

"  Idiocy  is  mental  deficiency  occurring  during  infancy  or  the  early 
periods  of  life."     J.  Langden  Down. 

"  Idiocy  is  mental  deficiency,  or  extreme  stupidity,  depending  upon 
malnutrition  or  disease  of  the  nervous  centers,  occurring  either  be- 
fore birth  or  before  the  evolution  of  the  mental  faculties  in  childhood. 
Imbecility  is  generally  used  to  denote  a  less  decided  degree  of  mental 
incapacity.  The  term  feeble-minded  is  now  much  used  in  the  United 
States  of  America,  both  in  legal  and  medical  documents,  to  denote 
both  idiots  and  imbeciles."     Ireland. 

"  Imbecility  is  simply  weakness  of  mind,  owing  to  defective 
mental  development,  and  may  be  of  every  degree  of  deficiency, 
moral  and  intellectual;  on  the  one  hand,  passing  by  impercep- 
tible gradations  into  idiocy,  and,  on  the  other  hand,  passing  in- 
sensibly into  ordinary  intelligence.  There  are  some  individuals  in 
whom  a  general  deficiency  of  intelligence  is  accompanied  by  a  singular 
development  of  it  in  a  special  direction;  they  manifest,  for  instance, 
a  surprising  memory  for  details,  such  as  dates,  names,  numbers,  the 
exact  particulars  of  distant  events,  which  they  recall  and  recount 
with  the  greatest  ease  and  accuracy,  or  display  certain  remarkable 
mechanical  aptitudes,  or  exhibit  a  degree  of  cunning  which  might 
seem  inconsistent  with  their  general  mental  feebleness." 

"  Idiocy  is  a  defect  of  mind  which  is  either  congenital  or  due  to 
causes  operating  during  the  first  few  years  of  life,  before  there  has  * 
been  a  development  of  the  mental  faculties,  and  may  exist  in  different 
degrees ;  the  person  affected  with  it  may  have  the  power  of  articulate 
speech  and  manifest  a  limited  degree  of  intelligence,  or  he  may  be 


DEFINITIONS. 


23 


utterly  destitute  of  any  semblance  of  intelligence  and  of  the  power 
of  speech,  being  little  more  than  a  vegetative  organism."  Maudsley. 
A  definition  which  I  have,  in  long  usage,  found  most  readilv  un- 
derstood, and  which  I  have  tried  to  make  inclusive  and  comprehen- 
sive as  well  as  simple  and  concise,  is  this :  Feeble-mindedness,  in- 
cluding idiocy  and  imbecility,  is  defect  either  mental  or  moral  or 
both,  usually  associated  with  certain  physical  stigmata  of  degenera- 
tion. Although  incurable,  its  lesser  forms  may  be  susceptible  of 
amelioration  and  of  modification,  just  in  proportion  as  they  have 
been  superinduced  by  causes  congenital  or  accidental. 


CHAPTER   II. 


HISTORY. 


By  the  Ancients  mental  defectives  were  regarded  as  objects  of 
derision,  aversion,  or  persecution.  The  awful  appellation  "  idiot  "  not 
only  inspired  horror  and  disgust,  but  meant,  for  the  unfortunate,  a 
forfeiture  of  all  human  rights  and  privileges.  So,  in  the  belief  that 
these  hapless  ones  were  accursed  of  the  gods,  or  in  an  effort  to 
preserve,  at  whatever  cost,  the  integrity  of  the  race,  the  practice  be- 
came common,  and  still  exists  among  certain  nations,  of  allowing 
the  mentally  deficient  to  perish,  or,  as  was  done  in  Sparta,  of  directly 
exposing  them  to  death-peril;  here  the  feeble-minded,  sharing  the 
fate  of  weakly  children,  were  thrown  into  the  Eurotas. 

Traces  of  this  custom,  found  in  the  laws  of  Lycurgus,  were  not 
confined  to  Sparta  alone.  Cicero  intimates  its  existence  among  the 
Romans.  At  the  present  day  a  similar  custom  exists  among  certain 
of  the  South  Sea  Islanders,  and  is  common,  likewise,  among  a  tribe 
of  American  Indians  distinguished  for  their  intelligence,  strength,  and 
physical  beauty.  This  effort  to  preserve  a  healthy  race,  cruel  as  it 
may  seem  in  individual  cases,  is,  after  all,  but  a  following  of  natural 
law;  the  buds  unfit  to  mature,  fall — the  weaklings  of  the  flock 
perish. 

Of  those  who,  in  ancient  days,  by  chance  escaped  these  drastic 
measures,  we  find  mention  now  and  again ;  but  plainly  as  set  apart, 
hedged  about  by  ridicule  or  scorn,  and  tolerated  only  for  the  sake  of 
diversion  and  amusement.  Such  were  found  in  the  houses  of 
Romans  of  rank.  Seneca  speaks  of  a  blind  imbecile — fatua, — who 
belonged  to  his  wife. 

That  some  have  escaped  both  conditions  and,  by  a  freak  of  fortune, 
have  filled  exalted  positions  is  not  to  be  questioned;  others  than 
Nero,  Commodus,  and  Elagabalus  have  worn  the  royal  purple. 

The  dawn  of  Christianity,  when  sorrowing  mothers  brought  to  the 
Great  Physician  their  demoniac  sons,  was  for  the  idiot  the  first 
gleam  of  beneficent  commiseration  and  divine  pity;  and  the  charge 

24 


Plate 


\s 


HISTORY.  25 

of  St.  Paul  to  "  comfort  the  feeble-minded  "  is  believed  by  some 
to  apply  more  to  these  unfortunates  than  to  those  weak  in  the 
faith.  In  direct  accord  with  this,  three  hundred  years  later,  when 
Constantine  Magnus  was  Emperor  of  the  West,  do  we  find  the  good 
Bishop  of  Myra  (the  St.  Nicholas  of  the  children  of  to-day)  recog- 
nizing and  tenderly  caring  for  the  idiot  and  the  imbecile,  and  the 
noble  Euphrasia,  closely  allied  to  the  imperial  household  of  Theodo- 
sius,  retiring  at  the  tender  age  of  twelve  to  the  convent  of  Thebiad, 
to  take  up  the  same  good  work. 

As  fools  or  jesters,  in  mediaeval  times  they  had  the  freedom 
of  the  castles  of  the  great ;  or  regarded  as  "  les  enf ants  du  bon 
Dieu,"  they  wandered  unmolested  in  Europe  as  in  the  Orient. 
Again,  viewed  with  superstitious  reverence  and  even  fear  as  being 
mysteriously  connected  with  the  unknown,  the  house  into  which  an 
imbecile  was  born  was  considered  blessed  of  God.  Proof  of  this 
commonly  accepted  belief  that  these  creatures  walked  on  earth  but 
held  their  conversation  in  heaven,  is  shown  in  the  fact  that  Tycho 
Brahe  had  for  his  close  companion  a  fool,  to  whose  mutterings  the 
great  astronomer  listened  as  to  a  revelation.  Among  the  Turks  of 
to-day,  and  in  many  parts  of  Ireland  and  of  Brittany,  this  same 
extravagant  idea  regarding  these  "  innocents  "  prevails.  In  Brazil 
an  imbecile  in  a  family  is  considered  more  a  joy  than  a  sorrow; 
rich  and  poor  alike  roam  the  streets  undisturbed,  soliciting  alms 
which  are  never  refused ;  in  this  way,  among  the  poor,  an  idiot  may 
be  the  sole  support  of  a  family.  The  American  Indian,  also,  allows 
these  "  children  of  the  Great  Spirit "  to  go  unharmed. 

Confucius  and  Zoroaster  in  their  writings  both  enjoin  a  tender 
care  of  these  unfortunates,  and  the  Koran  gives  this  special  charge  to 
the  faithful :  "  Give  not  unto  the  feeble-minded  the  means  which 
God  hath  given  thee  to  keep  for  them;  but  maintain  them  for  the 
same,  clothe  them,  and  speak  kindly  unto  them." 

During  the  reign  of  Edward  II.  we  find  it  enacted  that :  "  The 
King  shall  have  the  custody  of  the  lands  of  natural  fools,  taking  the 
profits  of  them  without  waste  or  destruction,  and  shall  find  them 
their  necessaries,  of  whose  fee  soever  the  lands  be  holden ;  and  after 
the  death  of  such  idiots  he  shall  render  the  same  to  the  right  heirs, 
so  that  such  idiots  shall  not  aliene,  nor  their  heirs  be  disinherited, 


26  HISTORY. 

and  a  portion  shall  be  distributed  for  his  soul  by  the  advice  of  the 
Ordinary." 

Yet  ever  misunderstood,  appearing  always  as  shadows  in  the 
brightest  spots  of  human  civilization,  for  them,  the  pendulum  again 
swings  backward ;  persecution  follows  close  upon  the  steps  of  super- 
stition, and  even  in  the  days  of  the  reformation  we  find  Martin 
Luther  and  Calvin  denouncing  them  as  "  filled  with  Satan." 

Although  many  individual  acts  of  kindness  may  have  passed  un- 
noticed during  the  lapse  of  ages,  the  first  intimation  of  organized 
effort  is  found  recorded  in  the  middle  of  the  seventeenth  century; 
its  birth-place  France,  and  its  cradle  the  Bicetre,  the  present  large 
asylum  and  hospital  of  Paris.  Obtaining  from  Anne  of  Austria 
permission  to  use  as  an  asylum  for  foundlings,  this  ancient  chateau, 
upon  the  ruins  of  which  Richelieu  had  begun  the  foundation  of  a 
military  hospital,  St.  Vincent  de  Paul  and  his  Confrerie  de  Charite 
gathered  there  the  children  from  the  city  and  the  provinces — the 
homeless,  the  outcast,  the  feeble  alike  in  mind  and  body. 

Whjle  these  devoted  Lazarites  were  gathering  together,  sheltering, 
and  striving  to  ameliorate  the  condition  of  imbeciles  in  France,  Juan 
Pablo  Bonnet  in  Spain  was  seeking  to  benefit  another  class — the 
deaf-mute ;  his  manual  alphabet  and  book,  entitled  "  Reduction  de  las 
Letras,  y  arte  para  ensenar  a  hablar  los  mudos,"1  destined,  in  an- 
other age,  to  give  to  deaf-mutes  a  language,  and  to  be  the  guide 
and  open  sesame  to  that  physiologic  education  that  should  unlock 
the  walls  of  deadened  sense  to  all  classes  of  defectives. 

The  eighteenth  century  was  undoubtedly  the  age  of  physiologic, 
as  the  nineteenth  was  of  psychologic  research.  While  Boerhaave, 
in  the  University  of  Ley  den  (1701-1731),  Morgagni,  in  the  Univer- 
sity of  Padua  (1712-1771),  and  Haller,  in  the  University  of  Gottin- 
gen  (1736-1753)  were  demonstrating  its  value  to  their  classes, 
philosophy  and  the  various  branches  of  anthropology  were  advanc- 
ing in  the  new  light,  and  education  found  in  it  the  key  to  a  true 
renaissance. 

Jean  Jacques  Rousseau,  in  his  daring  attack  upon  old  systems,  in 
his  book  "  Emile  "  a  revelation  of  the  new,  stands  as  the  acknowl- 
edged herald  of  reform  in  education.     Behind  him,  however,  is  one 

1  Madrid :    1620. 


HISTORY.  27 

to  whom  France  has  been  most  chary  in  awarding  praise ;  one  who, 
by  his  power  of  reducing  well-defined  theory  to  logical  practice,  far 
surpassed  that  more  brilliant,  but  most  inconsistent  and  erratic  genius. 
Outside  the  literature  of  the  deaf  and  dumb,  one  hears  but  little 
mention  of  Jacob  Rodrigues  Pereire.  A  Hebrew  of  the  Hebrews, 
this  man,  in  his  many  sidednesses,  seemed  prepared  to  be  "  all  things 
to  all  men  "  if  thereby  he  might  aid  .one.  His  varied  gifts  make  him 
a  fitting  type  of  an  age  of  discovery,  and  of  the  three  representative 
nations  of  that  age "  that  bestowed  them.  Portugal,  Spain,  and 
finally  France,  the  country  of  his  adoption,  had  each  a  share  in 
molding  the  man  in  whom  religion,  philanthropy,  and  science — 
mathematical,  physical,  social,  and  philologic — united,  stimulated  by 
enthusiasm,  and  tempered  by  a  prudence  and  modesty  that  were  truly 
admirable.  Through  his  able  biographer,  M.  Ernest  La  Rochelle, 
we  learn  of  his  curious  problems  in  calculus  and  mechanics,  which 
in  our  age  might,  possibly,  have  placed  him  foremost  among  in- 
ventors. An  adept  in  the  art  of  finance,  his  skill  as  a  negotiator  often 
succeeded  in  preventing  or  ameliorating  the  misfortunes  of  his  race, 
and  it  was  this  same  intense  sympathy  that  led  him  to  lend  his 
powers  as  linguist  and  philosopher  to  the  cause  of  the  deaf-mute. 
Using,  as  a  means  of  communication  with  his  pupils,  Bonnet's  alpha- 
bet, to  which  he  soon  added  some  forty  signs  of  his  own,  he  finally 
evolved  for  them  the  power  of  oral  speech.  Great  as  was  the  benefit 
to  these  unfortunates,  the  gain  to  science  was  greater. 

The  key-note  of  a  true  physiologic  education  was  struck,  when  he 
demonstrated  that  all  the  senses  are  modifications  of  the  single  sense 
of  touch;  the  spectacle  of  his  deaf-speaking  pupils  winning  from 
Buffon  the  acknowledgment  that  "  Nothing  could  show  more  con- 
clusively how  much  the  senses  are  alike  at  the  bottom,  and  to  what 
point  they  may  supply  one  another."  This  was  the  mission  he  ful- 
filled to  education  in  general ;  to  defectives,  however,  his  power  was 
even  more  far-reaching.  Seguin  tells  us  that  "  Pereire  analyzed 
speech  into  two  elements  :  the  sound,  and  the  vibration  which  produces 
it;  the  first  which  the  ear  alone  can  appreciate,  the  second  that  any 
flesh  vibrating  itself  may  be  taught  to  perceive.  He  conceived  that 
ordinary  men  hear  the  sound,  without,  most  of  the  time,  noticing  the 
vibrations ;  but  that  the  deaf,  who  cannot  hear  the  sound,  may  never- 


28  HISTORY. 

theless  be  made  the  recipients  of  vibrations.  Hence,  a  given  vibra- 
tion producing  only  a  given  sound,  the  deaf  taught  to  perceive  the 
vibration,  could  not  imitate  it  without  reproducing  likewise  the  corre- 
sponding sound  of  language.  It  is  thus  that  he  practically  made  his 
pupils  hear  through  the  skin,  and  utter  exactly  what  they  so  heard." 
Again,  as  M.  Leon  Vaisse  clearly  shows :  "  The  true  explanation 
of  Pereire's  success  in  his  self-imposed  work  of  education  should 
be  sought  in  the  meditations  of  the  philosophical  instructor  upon  the 
manner  of  action  of  the  human  mind,  and  upon  the  development  of 
language  in  childhood  independently  of  the  material  form  in  which 
the  language  itself  is  clothed.  Saboureux  de  Fontenay,  when  his 
pen  conveyed  so  exactly  the  delicate  shades  of  his  thought,  rendered 
to  his  master  an  homage  not  less  brilliant  than  did  Mile.  Marois 
when  she  succeeded  so  well  in  the  faculty  of  speech  which  his 
patient  and  intelligent  endeavors  had  restored  to  her." 

Pereire,  therefore,  in  teaching  these  unfortunates  the  art  of  think- 
ing, is  not  only  the  first  educator  of  deaf-mutes,  but  the  forerunner 
of  Valentine  Haiiy  to  the  blind,  and  of  Seguin  to  mental  defectives. 
At  once  an  exposition  and  an  inspiration  to  Rousseau  and  to  Itard, 
the  former  a  close  observer  in  his  school  in  Paris,  his  influence 
must  have  been  as  marked  in  the  creation  of  Rousseau's  "  Emile  " 
as  it  was  later  upon  Itard  in  his  experiment  with  "  the  Savage  of 
Aveyron,"  which  led  to  the  successful  demonstration,  by  Esquirol, 
Ferrus,  Voisin,  Seguin,  Vallee,  and  others  at  the  Bicetre,  of  possi- 
bilities in  the  training  of  mental  defectives. 

It  would  seem,  therefore,  that  we  are  justified  in  calling  France 
the  birth-place  of  the  new  education,  for  we  find  in  Paris,  at  the 
close  of  the  eighteenth  and  at  the  opening  of  the  nineteenth  century, 
this  rare  grouping:  The  establishment  of  the  first  school  where 
deaf-mutes  were  taught  to  speak  orally;  the  publication  of  the 
first  treatise  on  education,  whose  object  was  to  educate  in  the  true 
sense  of  the  word;  the  first  successful  demonstration  of  the  pos- 
sibility of  educating  an  idiot  by  physiologic  means  with  a  philo- 
sophic aim.  That  the  last  was  accidental,  detracts  in  no  wise  from 
its  value.  It  was  a  discovery,  and  Itard — although  unwittingly — 
the  discoverer  of  a  reflective  power  in  idiots  that  once  awakened, 
might  be  trained.     Thus,  as  Seguin  says :    "  The  idea  of  finding 


Plate  II 


HISTORY.  29 

modes  of  training  natural  and  yet  powerful  enough  to  bring  into 
physiologic  activity  impaired  functions  and  even  atrophied  organ- 
isms, did  not  come  directly  into  the  human  mind.  Like  nearly  all 
discoveries,  it  came  by  side  views  of  the  problem,  till  a  man  looking 
at  it  in  full  face  solved  it  by  a  mighty  effort." 

In  France,  in  1798,  a  boy  between  eleven  and  twelve  years  of  age 
was  seen  in  the  woods  of  Caune,  in  the  Department  of  Aveyron, 
seeking  for  acorns  and  nuts.  He  was  caught  by  a  party  of  sports- 
men and  brought  to  Paris,  where  his  education  was  undertaken  by 
Itard,  who  labored  with  him  for  five  years.  Interesting  alike  to  both 
history  and  science,  he  is  the  only  one  of  eleven  wild  children  whose 
story  is  not  enshrouded  more  or  less  in  legendary  or  traditional  lore. 
Of  these,  Seguin  gives  the  following  interesting  data : 

"  We  owe  to  the  great  Linnseus  a  list  of  ten  of  these  phenomena, 
which  he,  curiously  enough,  considered  as  forming  a  variety  in  the 
genus  Homo.  We  are  indebted  to  Bonaterre,  Professor  of  Natural 
History  in  the  Central  School  of  the  Department  of  the  Aveyron, 
France,  for  his  quotation  of  it,  for  curious  researches  upon  each  one 
of  these  ten  savages,  and  for  his  own  notice  of  the  eleventh,  '  the 
Savage  of  the  Aveyron.'  We  transcribe  from  our  own  copy  of  that 
extremely  rare  pamphlet. 

"  1.  Juvenis  Lupinus  Hessensis.  1544.  (A  young  man  found 
in  Hesse  among  wolves.) 

"  2.  Juvenis  Ursinus  Lithuanus.  1661.  (A  young  man  found 
among  bears  in  Lithuania.) 

"  3-  Juvenis  Ovinus  Hibernus.  Tulp.  Obs.  IV.  (A  young 
man  found  among  wild  sheep  in  Ireland.) 

"4.  Juvenis  Bovinus  Bambergensis.  Camerar.  (A  young 
man  found  among  herds  of  oxen  near  Bamberg.) 

"  5.  Juvenis  Hannoverianus.  1724.  (A  young  man  found  in 
Hanover.) 

"  6.  Pueri  Pyrenaici.  i 719.  (Two  boys  found  in  the  Pyre- 
nees.) 

"  7.  Puella  Transisalana.  1717.  (A  girl  found  in  the  Dutch 
Province  of  Over-Yssel.) 

"8.  Puella  Campanica.  1731.  (A  girl  found  in  Champagne 
and  since  named  Mile.  Leblanc.) 


30  HISTORY. 

"  9.  Johannes  Leodisensis.     Boerhaave.     (John  of  Liege.) 

"  10.  Puella  Karpfensis.     i 767.     (The  girl  of  Karpfen.) 

"  11.  Juvenis  Averionensis.  Anno  Reipublicse  Gallicae  octavo. 
(The  savage  of  the  Aveyron,  in  the  year  eighth  of  the  French  Re- 
public.)" 

This  last  Professor  Bonaterre  represents  as  unaccustomed  to  our 
food,  and  as  selecting  his  aliment  by  the  sense  of  smell ;  lying  flat 
on  the  ground,  and  immersing  his  chin  in  the  water  to  drink ;  tearing 
all  sorts  of  garments,  and  trying  constantly  to  escape ;  walking  often 
on  all  fours ;  fighting  with  his  teeth ;  giving  few  marks  of  intelligence ; 
having  no  articulate  language,  and  even  appearing  devoid  of  the 
natural  speech;  complaisant  and  pleased  at  receiving  caresses.  The 
Professor  thought  "  a  phenomenon  like  this  would  furnish  to  phi- 
losophy and  natural  history  important  notions  on  the  original  con- 
stitution of  man,  and  on  the  development  of  his  primitive  faculties ; 
provided  that  the  state  of  imbecility  zve  have  noticed  in  this  child  does 
not  offer  an  obstacle  to  his  instruction" 

The  revolt  from  the  old  system  of  education  had  naturally  given 
rise  to  many  schools  of  thought.  Of  these,  one  of  the  most  radical 
in  France,  influenced  probably  not  a  little  by  the  Revolution,  was  that 
of  the  sensualists  (according  to  later  views  and  in  order  to  avoid 
misconception  this  might,  perhaps,  be  better  translated  sensorists), 
who,  believing  that  all  ideas  were  derived  immediately  from  the 
senses,  taught  that  mental  perceptions  were  but  sensations  trans- 
formed. According  to  their  theory,  certain  ideas  were  generated 
through  the  repetition  of  certain  sensations,  and,  as  the  result  of  this 
persistency,  a  given  character  was  produced — a  sort  of  hybrid 
humanity,  so  to  speak — if  the  bent  of  the  subject  had  not  become 
biassed  or  warped  by  previous  impressions. 

The  sudden  advent  of  the  wild  boy  of  the  woods  was,  therefore, 
for  these  savants  a  golden  opportunity  for  reducing  this  theory  to 
practice,  and  none  so  qualified  for  this  task  as  their  confrere, 
Itard,  Physician  to  the  School  for  Deaf-Mutes,  versed  in  theory  and 
practice  of  the  physiologic  education  first  demonstrated  by  Pereire 
and  now  so  successfully  carried  forward  by  Abbe  de  L'Epee  and 
Abbe  Sicard. 

Thus  the  savage  of  Aveyron  might  be  likened  to  a  guide-post  read- 


HISTORY.  3 1 

ing  two  ways.  Standing  at  the  beginning  of  the  nineteenth  century, 
a  literal  symbol  of  the  parting  of  ways  for  his  caste,  in  this 
uncouth  figure  is  represented  all  the  cruelty  of  the  past  and  the 
beneficent  influences  of  a  new  era.  The  last  of  those  of  whom  his- 
tory or  tradition  speaks  as,  either  through  neglect  or  through  wilful 
desertion,  driven  from  the  haunts  of  men ;  he  is  also  the  first  example 
recorded  of  an  idiot  reclaimed  from  the  life  of  a  mere  animal  to  be 
trained  to  a  human  existence. 

Accepting  at  the  hands  of  Bonaterre  this  phenomenon  that  was  to 
"  furnish  to  philosophy  and  natural  history  important  ideas  on  the 
original  constitution  of  man,"  and  too  enthusiastic  to  heed  the  warn- 
ing concurred  in  by  Pinel,  Physician  in  Chief  to  the  Bicetre,  "  pro- 
vided that  the  state  of  imbecility  we  have  noticed  in  this  child  does 
not  offer  an  obstacle  to  his  instruction,"  Itard  gladly  entered  upon 
a  task  that  was  to  prove  the  theories  of  De  Condillac  and  the  creed 
of  the  sensualists,  in  a  program  fitted  to  cover  all  the  steps  from 
savagery  to  civilization.     Thus  he  was : 

"  I.  To  endear  him  to  social  life,  by  making  it  more  congenial 
than  the  one  he  was  now  leading ;  and,  above  all,  more  like  that  he 
had  but  recently  quitted. 

"  2.  To  awaken  his  nervous  sensibility  by  the  most  energetic 
stimulants;  and  at  other  times  by  quickening  the  affections  of  the 
soul. 

"3.  To  extend  the  sphere  of  his  ideas,  by  creating  new  wants,  and 
multiplying  his  associations  with  surrounding  beings. 

"  4.  To  lead  him  to  the  use  of  speech,  by  determining  the  exercise 
of  imitation,  under  the  spur  of  necessity. 

"5.  To  exercise,  during  a  certain  time,  the  simple  operations  of  his 
mind  upon  his  physical  wants;  and  therefrom  derive  the  applica- 
tion of  the  same  to  objects  of  instruction." 

Fortunately,  Itard  was  too  warm  a  humanist  to  be  a  mere  cold 
scientist.  Profoundly  interested  in  his  pupil  while  studying  his  needs 
and  striving  to  supply  them,  alternately  analyzing  and  synthesizing, 
he  modified  his  treatment  gradually  into  the  physiologic  methods 
'suited  less  to  the  savage  and  more  to  the  defective.  This  he  finally 
recognized,  although  he  did  not  formally  admit  it,  and  in  the  bitter- 
ness of  disappointed  hope  he  exclaimed :    "  Unfortunate !    Since  my 


32  HISTORY. 

pains  are  lost  and  my  efforts  fruitless,  take  yourself  back  to  your 
forest  and  primitive  tastes;  or,  if  your  new  wants  make  you  de- 
pendent on  society,  suffer  the  penalty  of  being  useless,  and  go  to 
Bicetre,  there  to  die  in  wretchedness." 

Firm  in  his  conviction  of  the  incurability  of  idiocy,  a  conviction 
shared  by  Pinel,  knowing  nothing  of  the  grades  of  imbecility,  he 
naturally  failed  to  see  the  intermediate  steps  of  educability  that  he 
himself  had  demonstrated.  Nevertheless,  in  his  report  of  the  work, 
he  does  recognize  that  he  had  "  made  a  collection  of  facts  capable 
of  enlightening  the  history  of  medical  philosophy,  the  study  of  un- 
civilized man,  and  the  direction  of  certain  kinds  of  private  education." 

This  modest  statement  of  disappointed  efforts  meets  with  the 
fullest  recognition  of  results  attained,  in  the  indorsement  of  the 
French  Academy  as  follows :  "  This  class  of  the  Academy  acknowl- 
edges that  it  was  impossible  for  the  institutor  to  put  in  his  lessons, 
exercises,  and  experiments  more  intelligence,  sagacity,  patience, 
courage;  and  that  if  he  has  not  obtained  a  greater  success,  it  must 
be  attributed  not  to  any  lack  of  zeal  or  talent,  but  to  the  imperfection 
of  the  organs  of  the  subject  upon  which  he  worked.  The  Academy, 
moreover,  cannot  see  without  astonishment  how  he  could  succeed  as 
far  as  he  did;  and  think  that  to  be  just  towards  M.  Itard,  and  to 
appreciate  the  real  worth  of  his  labors,  the  pupil  ought  to  be  com- 
pared only  with  himself;  we  should  remember  what  he  was  when 
placed  in  the  hands  of  this  physician,  see  what  he  is  now ;  and  more, 
consider  the  distance  separating  his  starting-point  from  that  which 
he  has  reached;  and  by  how  many  new  and  ingenious  modes  of 
teaching  this  lapse  has  been  filled.  The  pamphlet  of  M.  Itard  con- 
tains also  the  exposition  of  a  series  of  extremely  singular  and  inter- 
esting phenomena  of  fine  judicious  observations ;  and  presents  a  com- 
bination of  highly  instructive  processes,  capable  of  furnishing  science 
with  new  data,  the  knowledge  of  which  can  but  be  extremely  useful 
to  all  persons  engaged  in  the  teaching  of  youth."  Here  Itard  retires 
from  our  view,  and,  in  the  office  of  private  instructor,  applies  himself 
to  those  "  certain  kinds  of  education  "  before  alluded  to. 

His  mantle  falls  upon  one  well  fitted  to  systematize  his  views,  to 
adapt  them  to  the  treatment  of  idiots  at  large,  and  to  develop  from 


HISTORY.  33 

them  the  methods  for  the  education  of  mental  defectives  since  spread 
broad-cast  in  all  lands.     This  man  was  his  pupil,  Edward  Seguin. 

With  implicit  faith  in  the  discovery  that  Itard  had  unwittingly 
made,  Seguin,  in  1837,  m  a  private  school  in  Paris,  entered  upon  the 
task,  openly  avowed,  of  educating  the  idiot. 

Building  upon  the  theories  so  ably  demonstrated,  modifying  and 
adapting  them  directly  to  the  needs  of  his  pupils  as  experience  dic- 
tated, he  succeeded  in  building  up  a  system  of  training,  the  excel- 
lence of  which  as  certified  to  by  Esquirol,  won  for  him,  in  1842,  the 
directorship  of  the  school  for  idiots  at  Bicetre,  organized  in  1828  by 
its  chief  physician,  Dr.  Ferrus,  President  of  the  Academy  of  Medi- 
cine and  Inspector  General  of  the  Lunatic  Asylums  of  France,  and 
enlarged  in  1839  under  the  superintendence  of  Dr.  Voisin.  Ferrus' 
example  had  been  followed  by  Dr.  Falret  at  the  Salpetriere  in  1831. 
Seguin's  work  at  Bicetre,  the  result  of  which  he  published  in  two 
pamphlets,  won  encomiums  from  the  committee  of  the  hospital,  and 
later  the  indorsement  of  the  French  Academy  of  Sciences.  Within 
a  year,  however,  personal  difficulties  with  the  authorities  terminated 
his  engagement,  and,  leaving  the  work  under  the  able  direction  of 
M.  Vallee,  to  be  continued  along  the  lines  that  he  had  established, 
he  retired,  to  devote  himself  again  to  private  pupils  and  to  the 
preparation  of  his  work  on  idiocy,  "  Theorie  et  pratique  de  V  educa- 
tion des  idiots/'  the  initial,  one  might  say,  to  all  after-bibliography 
on  the  subject,  which,  honored  by  the  French  Academy,  elicited  an 
acknowledgment  from  Pope  Pius  IX.,  for  the  service  the  writer  had 
thus  rendered  mankind. 

Itard  and  Seguin  represent  two  practical  agents  developing  diverse 
schools  of  thought.  The  theories  of  Condillac,  the  master  and  friend 
of  Itard,  that :  "  the  faculties  of  our  mind  are  but  our  sensations 
transformed,"  and  that  "  all  simple  ideas  are  the  result  of  sensation 
alone,"  even  with  so  ardent  an  exponent  as  Itard,  failed  to  realize  and 
have  long  ago  been  rejected. 

Itard's  trustworthy  and  persistent  experimentation,  however,  re- 
vealed a  fact  never  before  suspected,  viz.,  that  idiots,  who  were  here- 
tofore accounted,  even  by  such  men  as  Pinel  and  Esquirol,  "  human 
brutes  "  or  "  beings  devoid  of  understanding  and  heart,"  possessed 
3 


34  HISTORY. 

a  reflective  intelligent  power  that  might,  if  once  awakened,  be  edu- 
cated. 

Seguin,  closely  observing  this  experiment,  naturally  recognized  the 
value  of  this  result  more  fully  than  did  Itard,  who  while  working  to 
demonstrate  a  different  idea,  was  overwhelmed  by  disappointment. 

Seguin,  starting  out  with  this  fact  established  for  him,  studying 
the  child  and  adapting  work  to  his  needs,  as  we  have  seen,  formed 
and  successfully  worked  out  the  theory  really  enunciated  by  Locke1 
and  universally  accepted  to-day,  of  an  intermediate  step — a  con- 
necting link  between  sensation  and  idea;  not  only  the  existence  of, 
but  the  necessity  for,  an  internal  intelligent  reflecting  power  that, 
seizing  the  notions  of  external  objects  as  furnished  by  the  senses, 
reasons  upon  them  and  produces  ideas ;  thus  the  senses  are  the  imme- 
diate agents  of  notions,  the  intelligence  the  immediate  agent  of  ideas, 
the  process  being  from  external  objects  by  the  medium  of  sensations 
to  notions,  and  from  notions  by  the  medium  of  the  intelligence  to 
ideas. 

The  results  of  Seguin's  experience,  the  necessary  requirements 
and  the  program  of  education,  are  briefly  embodied  by  him  in  the  fol- 
lowing clearly  expressed  abstracts. 

The  necessary  conditions  for  the  improvement  of  imbeciles  are 
that  "  the  treatment  be  not  only  hygienic,  but  moral ;  that  the  educa- 
tion be  not  the  putting  in  action  of  acquired  faculties,  which  is  the 
education  of  the  common  schools,  but  the  development  of  the  func- 
tions, of  the  aptitudes,  of  the  faculties,  and  of  the  instinctive  and 
moral  tendencies."  These  are  to  be  first  ascertained  by  a  careful 
physiologic  and  psychologic  examination  or  analysis  of  each  case 
and  the  program  of  education  follows: 

"  I.  The  moving  power. 

"  2.  The  senses. 

"  3.  The  perceptive  faculties. 

"  4.  By  gymnastics  of  comparison. 

"  5-  By  gymnastics  of  invention. 

"  6.  Excitement  of  sentiments  and  instincts  by  normal  necessities. 

"  7.  Special  excitation  of  the  faculty  of  spontaneousness. 

1  Locke,  The  Human  Understanding,  Bk.  II.,  chap.  I.,  sec.  4. 


HISTORY.  3  5 

"  8.  Incessant  provocation  to  regular  action,  to  speaking,  and  to 
the  exercise  of  faculties  then  developed. 

"  The  aptitudes  thus  created  are  then  applied  to  different  special- 
ties, according  to  the  fortune,  age,  or  position  of  each  individual, 
taking  care  to  choose,  in  every  case,  an  occupation  which  will  keep 
in  activity  the  muscular  system  as  well  as  the  mental  faculties." 

It  is  curious  to  note  how  with  nations  as  with  individuals,  a 
pioneer  in  a  work  is  rarely  the  one  to  reap  direct  advantage.  This 
fact  is  patent  in  the  case  of  each  of  the  individuals  we  have  been 
considering. 

France,  the  country  that  nourished  and  gave  to  the  world  a  Pereire, 
a  Rousseau,  an  Itard,  and  a  Seguin,  is  still  years  behind  other 
nations  in  the  matter  of  bestowing  free  education  and  has,  with  one 
exception,  made  no  extended  provision  for  mental  defectives.  This 
single  exception  exists  in  the  wonderful  work  of  John  Bost  and  his 
colony  at  La  Force,  near  Bordeaux.  In  thirty-four  years — from 
1846  to  1880 — this  remarkable  man  compassed  no  fewer  than  ten 
institutions ;  asylums  for  orphans,  idiots,  and  epileptics,  and  re- 
treats for  the  aged  and  for  the  outcast.  He  died  in  188 1,  within  a 
year  of  the  completion  of  his  work,  closing  a  career  hitherto  un- 
paralleled, and  not  since  emulated  by  his  countrymen. 

A  French  journal  thus  deplores  the  present  situation :  "  There  is 
no  doubt  that  of  all  abnormals  the  idiot  is,  with  the  cripple  (Vestropie) 
and  the  incurable,  with  us  the  least  provided  for.  There  are  in 
France  no  special  schools  for  these  unfortunates,  excepting  the 
Bicetre  and  the  Salpetriere,  and  these  receive  only  children  from 
the  Department  of  the  Seine."1 

Bourneville,  Physician-in-Chief  of  Bicetre,  makes  a  similar  state- 
ment in  his  report  of  1894 :  "  There  is  in  a  certain  number  of  coun- 
tries, especially  our  own,  an  unfortunate  class  of  children,  helpless 
and  incapable,  who  receive  hardly  any  assistance  or  treatment :  these 
are  idiots  and  degenerates." 

There  seems  to  have  been  no  disposition  to  follow  the  leading  of 
Seguin,  whose  purpose  it  was  to  form  special  private  classes,  for 
with  the  exception  of  LTnstitut  Medico-Pedagogique,  at  Vitry-sur- 
Seine,  established  in  1893  under  Bourneville's  immediate  direction, 

1  Revue  Internationale  de  Pedagogie  Comparative,  April,  1899,  p.  98. 


36  HISTORY. 

and  a  few  schools  for  backward  children  which,  however,  received 
only  boys,  France  at  the  close  of  the  last  century  did  not  fulfil  the 
promise  of  the  beginning.  To  France,  nevertheless,  is  due  the  grati- 
tude of  the  world  and  of  humanity  at  large ;  for  observation  and  ex- 
perimentation resulting  in  the  solving  of  a  philosophic  problem;  for 
the  correct  formulation  of  theory  based  upon  that  result;  for  the 
reduction  of  theory  into  practice  so  successful  as  to  lead  to  its 
adoption  by  all  countries ;  these  are  surely  laurels  upon  which  France 
can  afford  to  rest,  and,  moreover,  internal  strife  and  revolution  did 
but  prove  the  value  of  a  work  that  these  misfortunes  might  arrest, 
but  could  not  destroy. 

This  demonstration  did  not  come  too  soon,  for  the  silent  appeal 
of  the  idiot  was  already  creating  a  demand  for  this  very  supply  by 
making  pressing  claims  upon  the  energies  of  workers  in  other  fields. 

In  America,  Howe,  of  Boston  had  attempted  the  training  of  idiots 
among  the  children  in  his  asylum  for  the  blind — attempts  that  were 
followed  by  encouraging  results — and  the  Hartford  Asylum  for  Deaf- 
Mutes  had  been  forced  to  make  a  similar  experiment  with  the  idiots 
that  drifted  in  with  its  pupils.  In  Germany,  Saegert  was  having  a 
like  experience  in  his  asylum  at  Berlin,  and  Kern,  after  a  successful 
experiment  with  two  children,  was  preparing  to  open  his  institution 
at  Mockern.  In  England,  Reed,  in  the  pursuit  of  philanthropic  en- 
deavor, after  a  journey  through  Cornwall  and  Wales,  wrote :  "  From 
what  I  have  seen  I  think  an  asylum  for  needy  idiots  very  necessary. 
We  will  first  have  to  get  information,  then  the  practice  must  follow." 
About  the  same  time  Guggenbiihl,  with  all  his  sympathies  aroused 
in  behalf  of  the  cretins  of  Switzerland,  was  training  as  physician  in 
the  asylum  at  Hofwyl,  for  his  life-work  among  them. 

The  year  1842  saw  what  might  be  said  to  be  the  efflorescence  of 
this  growth,  for  we  note  an  almost  simultaneous  movement  in  three 
countries — the  more  singular  because  of  the  lack  of  intercourse  or 
of  preconcerted  action — to  establish  permanent  work  on  definite  lines 
similar  to  those  already  laid  down  by  Seguin  in  Paris.  He  himself, 
in  this  year,  was  to  introduce  his  methods  in  the  school  established 
by  Ferrus  and  Voisin,  at  the  Bicetre. 

Both  Saegert  and  Kern,  finding,  as  had  Howe,  the  impossibility 
of  attempting  the  co-education  of  two  classes  of  defectives,  opened 


Plate  IV. 


Case  B.  Case  C. 

IDIOTS  — PROFOUND  APATHETIC. 


HISTORY.  37 

private  institutions  for  the  training  of  idiots,  and  the  "  Abendberg," 
truly  a  beacon-light  set  upon  a  hill,  became  an  object-lesson  among 
the  nations. 

The  wretched  condition  of  the  cretins  in  the  valleys  of  Switzer- 
land had  been  a  subject  of  investigation  from  time  to  time,  and  had 
given  rise  to  a  voluminous  literature  on  the  subject  of  cretinism. 
Felix  Plater  mentions  it  as  early  as  1500;  Waif  gang  Hofer,  an  Aus- 
trian, physician  to  the  court  of  Vienna  in  1675 ;  and  the  writings  of 
Fodere,  a  Savoyard,  a  physician  of  repute  in  1792,  are  often  quoted. 
But  these  investigations  were  only  along  the  lines  of  study  and  re- 
search, and  evolved  no  plans  for  the  amelioration  of  the  cretin's  con- 
dition; they  had,  however,  the  merit  of  attracting  attention  and 
forming  a  basis  upon  which  others  could  work  with  this  aim  in  view. 

In  181 1  Napoleon  I.,  with  a  view  to  transplanting  families  and 
thus  effecting  a  cure  and  preventing  increase,  caused  a  census  to  be 
taken  of  cretins  in  Canton  Wallis,  Department  of  Simplon,  which 
showed  numbers  there  amounting  to  3,000.  This  undertaking  was 
frustrated  by  its  very  magnitude  and  by  the  unwillingness  of  the 
people  to  leave  their  homes. 

Now  and  again  we  find  mention  of  asylums.  Kohl  speaks  of  one 
at  Sitten,  in  Wallis,  and  another  at  Chur,  in  Graubiindten,  and  adds 
that  an  asylum  for  twelve  cretins  had  existed  for  ages  in  Admont. 
These  institutions,  of  course,  ministered  only  to  their  bodily  wants. 

In  1828  Guggenmoos,  a  teacher  of  Salzburg,  was  the  first  to  at- 
tempt any  form  of  mental  training;  he  failed,  as  did  the  Pastor 
Haldenwang,  in  1835,  at  Wildberg,  from  lack  of  aid  and  encourage- 
ment. The  year  1836,  however,  was  to  usher  in  a  promise  of  better 
things.  A  poor  deformed  cretin,  murmuring  his  prayers  before  a 
wayside  cross,  gave  an  impulse  to  a  life  that,  from  that  moment, 
became  devoted  to  the  one  cause.  Greatly  moved  at  the  sight,  and 
having  his  attention  drawn  to  various  forms  of  cretinism,  Guggen- 
biihl,  a  young  physician  of  Meilen,  Canton  Zurich,  settled  in  Sernf, 
in  the  valley  of  Clienthal,  Canton  Glarus,  for  two  years  in  order 
better  to  study  the  cretins'  condition.  Assured  that  much  could  be 
done  for  mind  and  body  by  systematized  effort,  he  determined  to 
found  a  hospital.  After  conferring  with  Fellenberg,  he  consented  to 
accept  from  him  the  post  of  physician  in  the  asylum  of  Hofwyl,  near 


38  HISTORY. 

Berne  and  leaving  his  few  poor  patients  in  Cleinthal  in  grief  at  the 
departure  of  their  beloved  physician,  he  entered  with  ardor  upon  a 
training  that  should  enable  him  to  bring  relief  to  the  many.  His 
efforts  in  behalf  of  these  afflicted  ones  however,  provoked  invidious 
criticism,  and  in  a  paper  entitled  "  Christianity  and  Humanity  in  Re- 
gard to  Cretinism  in  Switzerland  "  he  made  an  appeal  to  the  Swiss 
Association  for  the  Advancement  of  Science.  His  views  as  there  set 
forth  won  not  only  unqualified  approval,  but  his  plans  for  a  hospital 
were  emphatically  indorsed  in  this  wise :  "  The  knowledge  and  zeal 
of  Dr.  Guggenbiihl  would,  in  case  he  were  made  director,  un- 
doubtedly furnish  the  best  guarantee  of  success." 

Just  at  this  juncture  (1842)  a  plantation  on  the  Abendberg,  near 
Interlachen,  in  Canton  Berne,  4,000  feet  above  sea-level,  was  placed 
at  his  disposal  by  the  Swiss  forester  Kasthofer,  who  had  proved  that 
the  cultivation  of  plants,  and  hence  colonization,  was  possible  at  that 
height.  Cretinism,  in  rank  growth  in  the  valley  below,  was  unknown 
at  this  elevation,  where,  100  feet  from  the  summit  of  the  mountain, 
was  soon  erected  the  first  hospital  for  its  relief.  The  southern  slope, 
embracing  a  tract  of  some  40  acres,  was  speedily  dotted  with  cot- 
tages, the  general  work  of  the  establishment  being  committed  to  the 
care  of  the  Evangelical  Sisters  of  Mercy — Diakonissen. 

The  methods  there  pursued  we  find  were  closely  identical  to  those 
that  experience  was  dictating  likewise  to  Seguin  in  Paris,  modified 
according  to  the  especial  needs  of  the  cretin.  The  diet  was  simple, 
mainly  vegetable — except  potatoes — fruit,  milk,  eggs,  and  white 
bread,  with  very  little  meat.  , 

The  senses  were  continually  called  into  action  by  means  exagger- 
ated and  oft-repeated  but  frequently  changed  so  as  to  avoid  dulling 
by  monotony. 

The  benefits  of  altitude  were  augmented  by  free  life  in  the  open 
air,  with  inducements  for  constant  and  varied  exercise,  to  which  was 
added  the  stimulus  of  frequent  baths  and  of  massage. 

Guggenbiihl,  in  his  experiment,  had  not  only  proved  that  the 
cretin,  transported  at  a  tender  age  to  a  higher  and  purer  atmosphere, 
immediately  began  to  improve  physically,  but  he  sought  also  to 
utilize  the  glorious  panorama  of  nature's  wonders,  there  continually 
presented,  as  a  means  to  quicken  and  arouse  dormant  faculties  and 


HISTORY.  39 

to  fix  the  wandering  attention  of  the  child.  "  In  such  a  neighbor- 
hood/' he  tells  us,  "  all  the  phenomena  of  nature,  such  as  the  rising 
and  setting  of  the  sun  and  moon,  tempests,  thunder-storms,  rainbows, 
and  the  like,  are  seen  in  perfection  and  are  found  of  infinite  value 
in  awakening  the  sleeping  soul." 

Accounts  of  the  success  of  the  Abendberg  were  quickly  spread 
abroad,  and  scientists,  philanthropists,  and  physicians  alike  made 
pilgrimages  to  the  "  Sacred  Mount "  as  to  a  shrine,  returning  en- 
thusiastic champions  of  the  cause  of  the  idiot,  and  within  a  decade 
institutions  arose  in  America  and  England,  and  in  Germany,  and 
other  countries  of  Europe.  Urged  to  visit  these  institutions  and 
encourage  the  workers,  Guggenbuhl  went  from  place  to  place, 
heralded  everywhere  as  the  man  who  had  brought  the  gospel  of  new 
life  to  the  irresponsible  and  the  incapable. 

Enthusiasm  reached  its  zenith  in  the  middle  of  the  century,  when 
reverses  came,  the  tide  turned,  and  envy  and  suspicion  took  the 
place  of  admiration  and  confidence.  Allegations  of  abuses  led  to 
vituperations  and  to  reproaches  in  which  the  grossest  exaggeration 
found  voice,  and  now  hostility  obscured  truth  as  completely  as  adu- 
lation had  previously  done.  Finally,  an  investigation  instituted  by 
the  British  Minister  at  Berne  resulted  in  Guggenbiihl's  impeachment 
and  condemnation  as  a  charlatan,  and  in  the  withdrawal,  from  the 
Abendberg,  of  that  sympathy  and  support  of  the  Swiss  Association 
for  the  Advancement  of  Science  that  had  contributed  so  largely  to 
the  successful  founding  of  the  institution.  In  vain  did  Guggenbuhl 
publish,  through  the  Viennese  press,  indignant  protests  against  these 
censures;  his  enemies  were  too  strong,  his  voice  had  lost  its  power, 
his  institution  was  dissolved,  and,  retiring  to  Montreux,  he  died  in 
1863,  in  his  forty-seventh  year,  broken-hearted  before  reaching  his 
prime. 

"  Not  to  sit  in  judgment  on  the  man,"  says  Sengelmann,  "  The 
bow-string  was  strained  beyond  its  strength.  There  was  too  much 
promised.  To  those  who  insisted  on  seeing  the  fulfilment  of  all 
promises  it  was  necessary  to  present  '  parade  horses,'  and  this  pro- 
cedure could  not  satisfy  those  observers  who  penetrated  into  the 
character  of  it.  The  incense  of  adulation  weakened  his  sober  judg- 
ment.   To  this  it  must  be  added  that  during   Guggenbiihl's   fre- 


40  HISTORY. 

quent  absences  from  the  Abendberg,  abuses  crept  in  which  he  could 
not  at  once  detect  or  correct.  Later,  when  suspicion  was  once 
aroused,  his  religious  tendencies,  which  had  at  first  been  tolerated, 
were  made  to  appear  as  the  source  of  these  abuses,  and  he  was  un- 
justly stamped  as  a  hypocrite." 

In  reviewing  his  methods,  which  in  the  main  meet  the  demands  of 
and  are  indorsed  by  latter-day  experience,  we  cannot  but  acknowl- 
edge the  deep  insight  gained  by  this  man  into  the  needs  of  many 
forms  of  defect,  in  his  self-devoted  study  of  the  one;  an  insight  not 
alone  into  details,  but  far-reaching  in  scope.  That  he,  in  a  com- 
paratively narrow  sphere,  should  have  worked  out  and  foreshadowed 
the  colony  plan  of  the  large  institutions  of  to-day  is  as  marvelous  as 
it  is  admirable,  and  history  but  fulfils  a  tardy  act  of  justice  in  placing 
Guggenbuhl's  name  among  those  of  the  pioneers  in  a  work  to  which 
he  had  devoted  the  best  years  of  his  life. 

Cotemporary  with  Seguin  and  Guggenbiihl,  an  acknowledged  au- 
thority in  the  treatment  of  idiots,  and,  with  them,  influencing  the 
times  by  an  exposition  of  theory  and  practice  on  a  physiologic  basis, 
stands  Saegert,  Director  of  the  Asylum  for  Deaf-mutes  in  Berlin. 
Being  compelled  often  to  refuse  admission  to  children  too  feeble  in 
intellect  to  be  benefited  by  the  methods  pursued  in  this  institution, 
compassion  led  him  to  inquire  into  the  nature  of  their  infirmity  by  a 
process  of  psychologic  reasoning,  or  what  we  to-day  would  term  a 
study  of  abnormal  psychology.  In  1843,  experimentation  led  him 
as  it  had  Seguin  and  Guggenbiihl,  into  training  along'  physiologic 
lines,  which  attempt  was  attended  by  such  success  as  to  warrant  him 
in  bringing  the  matter  before  the  proper  authorities.  Failing  to 
secure  aid,  although  encouraged  by  the  Minister  of  Education,  he, 
in  1845,  determined  with  the  assistance  of  his  wife,  to  venture  upon 
a  private  enterprise. 

This  soon  attracted  the  attention  of  interested  visitors  who  came 
to  compare  his  work  with  that  of  Seguin  and  of  Guggenbiihl. 
In  his  monograph,  written  in  1846,  entitled  "  The  Cure  of  Im- 
becility by  Intellectual  Means,"  he  outlines  the  treatment  of  20  cases 
carried  out  in  his  institution  at  Berlin.  This  institution  was  later 
transferred  to  Dr.  Heyer  and  removed  to  Neustadt,  Eberswalde. 

Having  seen  the  power  of  devotedness  and  determination  working 


Plate   V. 


Case  C. 


IDIOTS  — PROFOUND  EXCITABLE. 


HISTORY.  41 

through  centuries  toward,  first  the  founding,  and  next  the  molding 
and  fashioning  of  the  work  into  definite  form  by  these  three  men — 
Seguin,  Guggenbiihl,  and  Saegert, — each  in  his  way  displaying  those 
certain  elements  of  success,  enthusiasm  and  singleness  of  purpose, 
the  result  is  no  longer  to  be  wondered  at,  but  may  rather  be  recog- 
nized as  a  foreordained  conclusion.  Moreover,  while  acknowledging 
the  remote  influences  of  Bonnet  and  St.  Vincent  de  Paul,  and  the  fact 
that  without  Pereiere  Itard  had  been  impossible,  we  must  admit 
that,  without  the  practical  working  of  Seguin,  Guggenbiihl,  and 
Saegert,  the  invaluable  theories  of  Pereiere  and  Itard  would,  for 
the  idiot,  have  remained  mere  hypotheses. 

Seguin,  himself  an  exile,  watched  from  afar  France  torn  by  internal 
dissension  unable  to  profit  by  his  teachings ;  Guggenbiihl  died  broken- 
hearted after  the  failure  of  the  Abendberg ;  Saegert,  more  fortunate 
than  his  compeers,  lived  to  see  their  hopes  and  his  own  realized  in 
his  native  land. 

We  will  now  discuss  briefly  the  able  following  of  such  leading 
in  different  countries. 

Germany,  awakened  at  last,  and  responding  to  the  call  for  popu- 
lar education,  had  workers  such  as  Kern  and  others  already  in 
the  field,  of  whom  Saegert  was  but  little  in  advance.  That  the 
times  were  ripening  toward  the  harvest  is  evident  from  the  signs 
in  various  directions  within  a  decade  after  the  opening  in  Berlin,  in 
1845,  °f  Saegert's  "  Institution  for  the  Cure  and  Education  of 
Idiots."  The  gathering  of  statistics  of  idiocy  by  the  governments — 
notably  those  of  Wurtemburg,  Sardinia,  and  Saxony ;  encouragement 
and  aid  in  founding  institutions;  the  discussion  of  the  subject  in  con- 
ferences of  philanthropists,  of  physicians,  and  of  clergy;  individual 
bequests  and  donations — these  efforts  often  reinforced  and  sustained 
by  charitable  organizations.  As  a  practical  result  we  find  a  record 
of  the  founding  of  no  fewer  than  32  training  schools  for  idiots  within 
a  period  of  thirty-five  years — from  1846  to  1881. 

Saxony  leads  all  the  German  governments  in  recognizing  the 
needs  of  the  idiot,  in  providing  the  first  state  institution  and 
in  making  training  compulsory  by  law.  Dr.  Ettmuller,  in  1844, 
in  a  lecture  on  "  The  Education  of  Idiots,"  delivered  at  Freiburg 
before  the  Saxon  Medical  Association,  made  such  an  impression 


42  HISTORY. 

that  the  Ministry  of  the  Interior  and  of  Education  were  won  over 
to  the  cause,  and  ordered  that  a  census  of  those  likely  to  be  benefited 
by  training  be  taken  by  the  district  authorities. 

The  teacher  Hornig  was  commissioned  to  observe  the  workings  of 
other  institutions,  with  a  view  toward  establishing  an  experimental 
school;  this  last  was  carried  into  effect  by  him  in  August,  1846,  at 
Hubertusburg,  the  number  of  pupils  being  limited  to  10.  In  No- 
vember of  the  same  year  the  charge  was  transferred  to  the  teacher 
Geasche,  and  under  him  it  became,  in  1852,  a  permanent  institution 
for  idiotic  children,  the  number  of  pupils  having  been  increased  to 
30 — all  boys.  In  1857  it  was  opened  to  both  sexes.  The  report 
issued  upon  the  occasion  of  its  twenty-fifth  anniversary  (1871)  gives 
valuable  information  regarding  the  work  done  in  shops  and  school- 
rooms, and  shows  a  register  of  46  pupils. 

Continuous  growth  necessitated  corresponding  expansion,  and 
over-crowded  conditions  were  relieved  by  the  separation  of  sexes  in 
two  large  buildings.  In  addition,  several  farms  were  acquired  that 
provided  occupation  for  many  of  the  inmates  who  averaged,  in 
1898,  about  550.  More  recent  advices  show  that  the  work  has 
since  been  diverted  into  asylum  and  hospital  channels,  the  more 
intelligent  being  transferred  by  the  authorities  to  the  Alsterdorfer 
institution. 

The  first  private  institution,  that  of  Kern,  at  Leipsic,  is  remarkable 
as  having  been  the  outgrowth  of  an  experiment  similar  to  that  of 
Saegert's  in  Berlin.  Its  director,  Dr.  Kern,  a  teacher  at  Eisenach, 
had  been  encouraged  by  the  success  that  had  attended  his  training 
of  some  deaf-mute  imbecile  children,  and  after  subsequent  study  and 
practice  in  the  deaf-mute  asylum  at  Leipsic  he  was  appointed  super- 
intendent of  a  similar  institution  in  his  native  town.  Here,  with  the 
approval  and  encouragement  of  the  authorities,  he  continued  to 
receive  idiots ;  soon,  however,  finding  the  two  incompatible  he,  early 
in  the  year  1847,  resigned  his  position  to  devote  himself  exclusively 
to  the  training  of  idiots  in  Leipsic.  His  institution,  later  removed  to 
the  neighboring  town  of  Mockern,  and  numbering  some  50  children 
at  the  time  of  his  death,  was  continued  under  the  supervision  of  his 
widow  and  his  son. 

Mariaberg  would  seem  to  have  been  especially  blessed  in  its  day 


HISTORY.  43 

and  its  generation.  A  daughter  of  the  Abendberg,  its  site  the  home 
of  prayer  and  good  deeds  through  many  years ;  its  first  office  the 
rescue  of  a  good  work  on  the  eve  of  failure,  and  on  that  foundation 
so  building  its  own  superstructure  that  its  influence  was  felt  at  home 
and  abroad;  legendary  lore,  religious  enthusiasm,  and,  finally,  scien- 
tific research  all  combine  to  give  its  history  the  true  atmosphere  of 
the  Rhineland. 

The  king  of  Wurtemburg,  returning  from  a  visit  to  the  Abendberg, 
was  filled  with  a  desire  to  emulate  Dr.  Guggenbiihl  in  ameliorating 
the  condition  of  similar  unfortunates  among  his  own  subjects. 
His  plans  found  an  enthusiastic  supporter  in  the  able  and  efficient 
Dr.  Rosch;  this,  too,  at  a  propitious  moment,  just  when  the  good 
Pastor  Haldewang,  who  since  1835  had  cared  for  a  few  cretins 
in  his  own  home  at  Wildberg,  felt  constrained  to  relinquish  his  labor 
of  love.  Here  was  a  nucleus  for  the  new  institution ;  there  remained 
but  to  provide  a  home. 

The  convent  of  Mariaberg,  one  of  the  dismantled  religious  houses 
of  the  period,  had  been  a  votive  offering,  and  owed  its  existence  to 
an  act  of  thanksgiving.  Playing  one  day  in  the  Lauchartgrund,  two 
children  of  Count  Hugo  von  Montfort  disappeared.  In  his  grief, 
the  distressed  father  vowed  to  the  Virgin  that  if  the  missing  ones 
were  returned  to  him,  he  would  build  a  convent  in  her  honor.  A 
search  was  instituted,  and,  among  the  stacks  in  the  barnyard,  under 
the  hay,  the  two  children  were  discovered  asleep.  The  father  kept 
his  vow,  and  the  "  Convent  Berg  of  Our  Lady  "  rose  upon  the  hill. 

It  was  in  this  place,  consecrated  by  its  association  with  the  inno- 
cence of  childhood,  with  parental  love  and  gratitude,  and  with  lives 
of  unselfish  devotion  that  the  work  of  the  good  pastor  was  to  be 
revivified  and  the  hopes  of  the  king  realized.  Dr.  Rosch,  with  13 
charges,  10  of  whom  were  from  Wildberg,  took  possession  of  the 
building  placed  at  his  disposal,  and  on  May  6th,  1847,  tne  institution 
was  formally  opened  with  appropriate  services  in  the  chapel. 
Besides  enjoying  royal  patronage — the  Crown  Princess  Olga  was  its 
protectress — the  office  of  general  director  has  been  filled  successively 
by  men  of  high  professional  standing,  such  as  Helferich,  Zimmer, 
Kraft-Rail,  Rosch,  Autenrieth,  Griesinger,  Prelate  von  Beck,  von 
Schwanden,  and  Neudorfer. 


44  HISTORY. 

The  work,  at  first,  aimed  to  be  solely  educational,  but  the  necessity 
for  a  custodial  department  soon  became  apparent;  this  addition  was 
finally  effected,  in  i860.  Experience  next  dictated  another  exten- 
sion, and  in  1874,  through  the  persistent  efforts  of  Director  von 
Schwanden,  an  extensive  farm,  of  from  300  to  400  acres,  was 
acquired,  fore-shadowing  the  colony  plan  of  the  future.  This  last 
acquisition  gave  a  definite  aim  to,  as  well  as  greater  opportunities 
for  training,  and  placed  the  institution  on  a  substantial  basis,  so  that 
to-day,  with  175  inmates,  it  ranks  among  the  successful  institutions 
of  Germany. 

Founded  in  1850,  the  Alsterdorfer  institution  manifests  a  con- 
tinuous growth.  Every  addition  has  been  made  in  compliance  with 
demands  made  evident  by  experience,  and  at  the  close  of  a  half  cen- 
tury's existence,  it  presents  every  provision  for  a  model  charity 
colony.     Among  the  buildings  that  go  to  make  up  this  colony  are: 

1.  The  St.  Nicholas  Stift:  a  home  for  friendless  normal  children, 
erected  in  1850. 

2.  The  Asylum  for  Idiotic  and  Feeble-Minded  Children,  erected  in 
1863. 

3.  The  Home  for  Cripples  (normal  children),  built  in  187 1. 

4.  A  School  for  Defectives  of  the  wealthier  class,  including  epi- 
leptics, erected  in  1882. 

5.  Hospital  and  isolation  wards,  built  in  1897. 

The  St.  Nicholas  Stift,  somewhat  similar  to  our  societies  for  pro- 
tection from  cruelty,  aims  to  rescue  children  from  irresponsible  par- 
ents or  from  vicious  environment.  Its  founder,  the  good  Dr.  Sengel- 
mann,  within  a  few  years  resigned  his  pastorate  to  devote  himself 
exclusively  to  the  work,  as  an  unsalaried  director.  The  asylum  for 
feeble-minded  owes  its  origin  to  the  need  he  felt,  during  the  early 
days  of  his  ministry,  of  providing  for  a  homeless,  idiotic  child. 
With  a  register  of  4  children  at  its  beginning,  it  is  now  complete  in 
all  departments — custodial,  educational,  and  household.  Epileptics 
are  received,  186  of  them  being  cared  for  at  the  present  time. 
Situated  on  the  banks  of  the  Aester  River,  near  Hamburg,  amid 
beautiful  and  healthful  surroundings,  this  institution,  with  a  staff 
composed  of  one  director,  two  physicians,  and  a  principal  of  schools, 
is  caring  for  655  unfortunates.     It  comprises  42  buildings,  including 


Plate  VI. 


A" 

'-.-■-  ;V^>5S'  ■ 

;  ~'T'1*& 

^llpi 

gk 

►"-.  "1 

;w       ^.-    ^, 

;  --f    ^ 

•% 

2pP^''; 

l»£    'v  i  *     Y. 

*''^^«SL»Jr 

W^y 

A~ 

^/H 

/■'          ^^ 

/ 

Contents  of  Stomach  of  Case  C. 
IDIOTS  — SUPERFICIAL  APATHETIC. 


HISTORY.  45 

a  church  and  a  school  for  no  pupils  divided  into  8  classes.  A 
large  farm,  gardens,  and  hothouses  give  healthful  occupation  to 
many,  while  in  the  various  shops  every  trade  is  represented. 

The  enterprise  has  been  private  from  its  inception.  It  has  received 
but  one  appropriation  from  the  government,  but  liberal  and  repeated 
donations  have  made  possible  this  extension  and  the  acquisition  of 
property  valued  at  not  less  than  half  a  million  marks. 

Langenhangen,  founded  in  1862;  Kuckenmiihle,  in  1863;  Polsin- 
gen  and  Stetten,  in  1866,  stand  foremost  among  the  German 
institutions  for  mental  defectives  whose  efforts  have  been  directed 
toward  the  amelioration  of  epilepsy;  while  Bielefeld,  in  1870  and 
Rothenburg,  in  1880  are  asylums  established  primarily  for  this 
afflicted  class. 

In  the  Kingdom  of  Hanover  the  census  of  1856  showed  an  idiot 
population  numbering  1,200,  and  that  of  i860  showed  some  500 
under  the  age  of  fifteen.  Through  the  agency  of  both  press  and 
pulpit,  interest  was  aroused  that  resulted  in  the  establishment  of  a 
fund  and  the  appointment  of  a  committee  to  consider  the  erection, 
at  various  points,  of  educational  and  home  institutions  for  feeble- 
minded children.  The  sole  result  of  this  movement,  however,  was 
the  founding  of  Langenhangen,  whose  growth  bears  evidence  that 
it  was  a  response  to  a  pressing  need.  It  opened  in  January,  1862, 
with  30  inmates.  In  1868,  when  Dr.  Kind,  who  had  gained  an 
experience  both  as  a  teacher  and  a  physician  under  Dr.  Kern,  at 
Mockern,  came  to  take  charge,  the  number  of  inmates  had  increased 
to  170.  From  this  time  on  there  was  a  continued  increase  up  to 
300  patients,  with  a  proportionate  increase  in  the  number  of  epilep- 
tics. Combining  the  two  classes  of  unfortunates  did  not  prove  en- 
couraging and  experience  pointed  to  the  advisability  of  separation. 

The  report  of  1902  showed,  under  state  provision,  709  patients, 
of  whom  151  were  epileptics;  and  28  buildings,  in  addition  to  two 
hospitals  and  a  school  of  10  classes. 

In  Pomerania,  stirred  by  the  home  missions  and  the  writings  of 
Disselhof,  the  provincial  government  caused,  in  i860,  a  census  to 
be  taken  of  the  idiot  population.  This  showed  that  of  625  idiots, 
300  were  reported  as  capable  of  receiving  instruction,  and  254  were 
paupers.     An  appeal  for  financial  assistance  through  the  columns 


46  HISTORY. 

of  The  Messenger,  brought  in  only  a  small  amount,  but  nothing 
daunted,  its  editor,  Gustave  Yahn,  did  not  cease  to  agitate  the  sub- 
ject. In  his  own  name  and  at  his  own  risk  he  bought  a  property 
just  then  offered  for  sale,  a  water-mill,  Kuckenmuhle,  to  be  used 
as  a  home  for  these  helpless  ones.  His  enthusiasm  overcame  many 
obstacles ;  donations  and  grants  of  land  followed  in  quick  succes- 
sion. A  board  of  directors,  made  up  of  a  body  of  energetic  men, 
was  formed,  and  in  1863  the  cornerstone  of  an  institution  was  laid 
that,  for  phenomenal  and  rapid  growth,  has  surpassed  all  other  Ger- 
man institutions — Bielefeld  alone  excepted. 

In  one  year  it  showed  an  increase  of  from  4  to  33  patients,  and  in 
1871  it  numbered  100.  In  188:2  Tabor,  a  branch,  was  added  provid- 
ing for  epileptics.  The  report  of  1902  shows  920  inmates — 330 
being  epileptic;  52  houses — 23  for  patients  and  7  for  officers;  22 
farm  houses ;  2  hospitals ;  a  church ;  a  gymnasium ;  and  a  school  of  8 
classes.  The  institution  continues,  a  private  corporation  under 
state  patronage. 

Neuendettelsau  was  founded  in  1855  by  Johannes  C.  W.  Lohe, 
whose  life  repeats  for  Germany  the  story  of  Andrew  Reed  in  Eng- 
land and  John  Bost  in  France.  Two  mission  houses,  an  order  of, 
Diakonissen,  and  a  Sister  House,  with  schools,  hospitals,  and  more 
than  one  idiot  asylum,  attest  to  his  devoted  service  to  the  brother- 
hood of  man. 

Polsingen,  an  offshoot  of  Neuendettelsau,  was  founded  in  1866,  as 
a  provision  for  the  male  idiots.  The  institution,  which  is  strictly 
private,  reports  in  1902,  4  buildings,  sheltering  120  patients — 25  of 
whom  are  epileptics — and  a  school  of  30  pupils. 

Stetten  owes  its  existence  to  a  society  of  pietists  of  Wurtem- 
berg,  who  with  two  children,  in  the  spring  of  1849,  began  work  in 
the  castle  of  Rieth.  The  rapid  growth  of  the  institution  twice  made 
removal  necessary,  the  first  to  Winterbach,  and  again  to  the  castle 
of  Stetten,  where,  in  1866,  it  was  further  enlarged,  so  as  to  gain 
room  for  epileptics,  providing  asylums  and  physicians  for  specific 
study  and  research.  The  report  of  1902  shows  442  patients,  216 
of  whom  are  epileptics,  with  6  large  buildings,  in  addition  to  a 
hospital,  a  gymnasium,  and  a  school-house  with  eleven  class-rooms. 
Stetten  is  a  private  institution  deriving  state  aid. 


HISTORY.  47 

By  far  the  largest  and  most  successful  effort  in  behalf  of  epi- 
leptics is  Bethel,  near  Bielefeld,  Westphalia,  fitly  termed  "  A  Col- 
ony of  Mercy."  This,  like  Mariaberg,  had  its  foundation  in  an 
act  of  thanksgiving.  The  good  pastor  von  Bodelschwingh,  at  the 
beginning  of  the  work,  seeking  for  some  means  to  provide  for  epi- 
leptics, issued  an  appeal  to  the  mothers  of  Germany  for  a  thank- 
offering  for  each  perfect  child  born  to  them.  The  pennies  came 
showering  in,  and  among  them  two  from  a  sorrowing  mother,  who 
gave  thanks  for  two  infants  gathered  safely  in  the  arms  of  "  Him 
who  loveth  children."  "  A  widow's  offering "  of  6,000  marks, 
brought  likewise  a  happy  suggestion  that  the  families  of  all  patients 
received,  be  asked  to  contribute  a  penny  a  day.  The  collection  from 
this  source  amounting  in  one  year  to  38,260  marks,  has  become  a 
permanent  and  important  source  of  revenue  as  is  also  that  collected 
regularly  from  almsboxes  in  public  places.  These,  together  with 
donations  and  fees  from  private  patients,  contribute  largely  to  the 
maintenance  of  this  noble  and  far-reaching  charity. 

Begun  in  the  autumn  of  1867  with  3  patients,  at 'the  close  of 
its  seventh  year  it  reports  a  list  of  144 ;  having  received  in  that  time 
450  patients.  Adding  house  to  house  and  land  to  land,  enlarging 
operations  as  experience  and  necessity  indicated,  it  stands  to-day  a 
model  village  which,  with  its  outlying  farm  and  park-lands,  pro- 
vides every  convenience  for  its  large  population. 

The  original  Bethel  continues  the  home  of  the  brighter  epilep- 
tics, separated  from  the  feeble-minded  who  are  cared  for  in  smaller 
buildings,  the  institutions  being  known  collectively  as  the  "  Zion 
Institutions."  These  provide  for  the  homeless  a  home,  for  the 
sick  hospitals — from  which  also  remedies  are  sent  all  over  the 
world,  benefiting  it  is  estimated  over  50,000  persons — and  for  the 
hopeless  and  despondent  that  greatest  of  all  panaceas,  work,  more 
than  20  different  trades  and  avocations  being  pursued,  exclusive  of 
those  of  the  household ;  6  pastors  and  12  physicians  are  in  charge. 

In  the  first  thirty  years  5,028  persons  were  received  and  discharged, 
about  30  per  cent,  being  improved.  The  report  of  1902  shows  1,771 
inmates,  quartered  in  45  buildings,  with  60  buildings  for  officers 
and  caretakers.  There  are  churches,  gymnasiums,  and  roof-gar- 
dens, an  electric  plant,  an  assembly  hall  with  a  seating  capacity  of 


48  HISTORY. 

1,500,  4  hospitals,  and  2  school-houses,  in  which  180  children  receive 
instruction. 

The  Municipal  Institution  for  Epileptics  at  Berlin  provides  for 
1,082  epileptics.  Receiving  only  residents  of  that  city,  it  is  a  village 
in  itself  comprising  50  houses,  including  a  school  of  6  classes  and  7 
hospitals ;  1  for  children,  2  for  men  and  women,  2  custodial,  and  2 
isolation. 

Rothenburg,  private,  was  the  direct  work  of  a  benevolent  society 
having  some  350  members.  It  was  opened  for  epileptics  January 
4,  1880,  as  an  asylum  with  5  children;  the  number  speedily  increas- 
ing to  75 ;  the  growing  institution  soon  comprised  5  houses,  a  school 
with  20  children,  and  5  hospital  stations  where  patients  receive  treat- 
ment. At  the  present  time  there  are  9  buildings  and  a  school,  mak- 
ing provision  for  186  patients. 

In  providing  for  the  idiot,  Denmark  leads  the  Scandinavian  coun- 
tries. The  inception  of  the  work  is  due  to  the  energy  of  Dr.  J.  R. 
Hiibertz,  who  under  the  patronage  of  the  Queen  Dowager,  Caroline 
Amalie,  was  enabled  in  1852,  to  visit  and  observe  in  foreign  institu- 
tions. Returning  from  this  valuable  preparation,  his  efforts  to  bring 
before  the  public  the  pressing  needs  of  the  idiot  resulted  in  the  pur- 
chase of  a  farm  near  Copenhagen,  Gamle  Bakkehus,  and  the  open- 
ing of  a  small  private  institution,  in  1855,  which  the  unremitting  zeal 
of  its  superintendent,  Pastor  Durloo,  has  maintained  for  some  forty- 
seven  years.  Increased  to  4  departments — Gamle  Bakkehus,  Eb- 
berodgaard,  Lillemosegaard,  Karens  Minde — with  a  capacity  for 
some  900  patients,  it  now  receives  a  subvention  from  the  Govern- 
ment, and,  under  the  supervision  of  the  Minister  of  Public  Instruc- 
tion, it  provides  for  the  eastern  part  of  the  kingdom,  just  as  the 
Keller  Institutions  now  do  for  the  western.  These  latter — founded 
by  Johan  Keller  in  1856,  and  continued  by  his  son,  Dr.  Christian 
Keller — of  which  there  are  two,  one  near  Copenhagen,  providing 
for  250,  the  other,  Brejning  (Jylland),  with  a  capacity,  now  nearly 
reached,  for  700  children,  include  asylums,  day-schools  for  backward 
children,  a  farm  colony,  and  work-shops  for  training  in  the  various 
handicrafts. 

The  first  idiot  asylum  in  Sweden  was  organized  by  the  army  chap- 
lain Glasell,  in  1863.     Miss  Emanuella  Carlbeck,  who  took  charge 


HISTORY.  49 

of  it  in  1866,  later  became  the  founder  of  the  institution  at  Skofde, 
toward  which  the  government  contributed  5,920  kroners  annually. 
Success  here  led  to  the  founding,  in  1870,  in  Stockholm,  of  a  society 
for  the  education  of  feeble-minded  children,  Professor  Kjellberg,  Dr. 
O.  von  Feilitzen,  and  Dr.  Theol  F.  Grofstrom  being  leaders  in  this 
movement. 

An  appeal  from  this  society  enlisted  the  sympathy  of  all  sec- 
tions of  the  country,  and  funds  were  gathered  sufficient  to 
aid  in  the  enlargement  of  the  institution  at  Skofde  and  also 
to  found  one  at  the  capital.  Conferences  of  teachers  for  defec- 
tives— blind,  deaf,  and  idiotic  children — were  inaugurated,  and  for 
the  purpose  of  assisting  in  the  work  of  the  training-schools  there  was 
established,  in  Stockholm,  in  1878,  a  school  for  backward  children 
and  a  class  providing  for  the  training  of  eight  teachers,  the  course  in 
theory  and  practice  covering  a  period  of  two  years.  This  received 
an  annual  subvention  of  9,500  kroners  from  the  government. 

At  present  there  are  33  institutions  in  Sweden,  including  schools 
for  the  trainable,  workshops  for  those  completing  a  course  in  the 
schools,  and  asylums  for  the  unimprovable.  These  are  supported 
by  societies,  by  city  councils,  and  by  private  donations.  The  gov- 
ernment also  adds  an  appropriation  of  250  kroners  for  each  child  in 
the  school  and  100  for  each  pupil  in  the  shops.  The  number  pro- 
vided for  in  these  institutions  amounted,  in  1902,  to  881. 

Small  establishments  are  considered  preferable  to  large  ones,  and 
no  one  of  these  numbers  over  82  pupils.  A  large  proportion  are 
directed  by  women,  of  whom  also  the  teaching  force  is  largely  com- 
prised. The  schools  are  divided  into  three  classes  of  one  year  each, 
with  a  preliminary  course  of  two  years,  during  which  time  the  child 
is  carefully  studied  in  order  to  judge  of  his  ability  to  receive  training. 

The  program  is  that  of  the  primary  schools ;  language  lessons, 
catechism,  the  history  and  geography  of  Sweden,  natural  science, 
writing,  arithmetic,  drawing,  singing,  physical  training,  and  most 
schools  add  a  training  in  household  employment,  manual  training  in 
wood,  basket-making,  brush-making,  shoemaking,  and  gardening. 
As  Sweden  was  the  first  country  to  employ  manual  work  with  a 
pedagogic  aim,  this  system  has  been  found  especially  adapted  to  the 
education  of  mental  defectives,  where  practical  teaching  finds  favor- 

4 


50  HISTORY. 

able  soil  and  proves  an  excellent  means  of  developing  intelligence. 
Workshops  have  been  established  especially  for  those  going  out  from 
the  schools,  as  it  has  been  proved  that  this  class,  however  skilled, 
can  never  compete  successfully  with  normal  labor.  The  shops  for 
men  are  usually  located  in  the  country,  where  the  inmates  can  be 
employed  successfully  in  farming,  gardening,  and  the  care  of  stock ; 
under  direction  they  show  good  capacity  for  these  occupations. 
The  shops  for  women  are  located  chiefly  in  the  towns,  and  the  ex- 
penses are  practically  defrayed  by  the  sale  of  the  work,  which  con- 
sists of  tapestry  and  carpet-weaving,  sewing,  quilting,  and  lace- 
making.  There  is  an  asylum  in  almost  every  school,  although  it 
must  be  said  that  Sweden  displays  but  little  interest  in  this  branch 
of  the  work,  preferring  to  admit  to  its  institutions  only  those  who 
are  trainable.  The  total  number  of  mental  defectives  in  Sweden, 
according  to  the  last  census  of  1890,  was  7,619,  being  about  159  to 
every  100,000. 

In  Norway  attention  was  first  attracted  to  the  needs  of  the  idiot 
by  Dr.  Ludvig  Dahl.  Experiments  were  begun  in  1871  by  Mr. 
Hanson  and  Mr.  Lippestad,  both  having  had  previous  experience 
with  deaf-mutes.  After  the  number  of  their  pupils  had  increased 
to  40,  a  separation  of  the  sexes  being  found  desirable,  Mr.  Lippe- 
stad purchased  a  farm  and  opened  at  Christiania,  with  17  girls,  the 
institution  of  Thorshaug,  which,  numbering  now  some  200,  still  con- 
tinues under  his  direction.  Sent  by  his  government  to  visit  the  in- 
stitutions of  Germany,  he  added,  after  his  observations  there,  a  de- 
partment for  epileptics. 

The  institution  for  boys,  having  capacity  for  100,  was  continued 
by  Mr.  Hanson  at  Ullersvedsvien,  and  a  third  institution  was  opened 
near  Bergen,  of  which  J.  Salthre  is  superintendent,  it  having,  accord- 
ing to  latest  advices,  40  inmates. 

The  Compulsory  School  Act  of  Norway  includes  imbeciles,  and 
since  1892  all  institutions,  as  also  the  classes  for  backward  children, 
are  under  state  control.  Norway  and  Saxony  are  the  only  countries 
in  Europe  where  education  is  compulsory  alike  for  normal  and  ab- 
normal children.  Although  few  in  number,  the  Norwegian  institu- 
tions are  considered  models  as  regards  buildings,  management,  and 


HISTORY.  5 1 

methods,  the  chief  characteristics  being  complete  separation  of  the 
sexes,  and  small  classes,  thus  giving  opportunity  for  individual  at- 
tention, and  training  for  some  special  life  occupation ;  for  the  girls, 
chiefly  dairy  and  household  work  and  country  pursuits ;  for  the  boys, 
trades  in  the  towns,  where  they  are  placed  in  situations  and  kept 
under  observation.  Untrainables  are  rejected,  the  government  mak- 
ing no  special  provision  for  idiots. 

In  Russia  the  institution  at  Riga,  founded  in  1854  by  Friedrich 
Platz  (a  former  teacher  of  deaf-mutes),  passed  at  his  death,  in  1864, 
into  the  hands  of  his  widow,  who  attempted,  with  some  success,  to 
carry  out  Georgens'  and  Froebel's  ideas. 

In  Finland  a  census,  not  altogether  reliable,  shows  the  number 
of  idiot  children  between  the  ages  of  seven  and  twenty  years  to  be 
not  less  than  2,500.  In  1876  a  small  school  of  9  pupils  was 
opened  in  Jakobsstad,  Finland,  by  Mr.  M.  K.  Lundberg,  under  a 
council  of  pedagogues,  to  the  support  of  which  the  government  con- 
tributed. This  led,  in  1883,  to  the  establishment  of  special  schools. 
A  private  school  established  by  Edwin  Hedman  in  Helsingfors 
in  1890  under  state  patronage  cares  for  60  pupils,  receiving  children 
from  both  Finland  and  Russia;  it  has  also  an  asylum  department 
for  untrainables. 

All  institutions  for  defectives  are  now  under  the  direction  of  the 
Superintendent  of  Public  Instruction,  with  a  special  inspector. 

In  Turkey  and  Armenia,  as  also  in  Greece,  there  is  no  provision 
for  mental  defectives  other  than  in  hospitals  for  the  insane. 

In  Holland  a  spirit  of  emulation  was  early  awakened  by  a  visit  of 
the  Queen  of  the  Netherlands  to  the  Abendberg,  and  a  movement 
toward  practical  work,  proposed  and  advocated  by  the  Court 
Preacher  Van  Koetsvelt,  in  an  able  work  on  idiocy  and  its  cause, 
led  to  the  establishment  of  a  day-school  for  trainable  imbeciles, 
which  opened  at  the  Hague  in  1855  with  31  pupils.  Obstacles, 
financial  and  legal,  combined  to  prevent  work  on  a  more  extended 
scale.  These,  overcome  within  two  years,  and  a  suitable  building 
purchased,  the  school  found  its  permanent  home  in  an  institution 
that,  in  1902,  reported  78  pupils  provided  for. 


52  HISTORY. 

The  official  visit  of  Count  Bombeller,  the  Austrian  Ambassador, 
to  Switzerland,  and  to  the  Abendberg,  directed  the  attention  of  "his 
countrymen  to  the  necessity  of  taking  a  census  and  making  some 
provision  for  idiots.  This  was  further  emphasized  in  1857  by  an 
appeal  from  Guggenbiihl  himself  to  the  Vienna  Academy  of  Sci- 
ences, and  a  school  for  idiots  was  opened  in  the  blind  asylum  at 
Ybbs,  in  1864,  which  numbered  some  40  pupils. 

State  pupils  were  also  received  by  Georgens  in  the  Levana,  at 
Liesing  near  Vienna,  but  religious  differences  tended  to  defeat  the 
benevolent  purposes  alike  of  himself  and  of  the  government. 

In  Prague,  in  1870,  an  asylum  having  a  capacity  of  300  was 
founded  by  a  charitable  society.  The  Stephanie  Asylum,  under  the 
patronage  of  the  Crown  Princess,  was  opened  in  1883,  at  Bieder- 
mansdorf  near  Vienna,  receiving  27  pupils. 

A  hospital  for  the  relief  of  mental  defectives  was  erected  at  Gratz, 
planned  by  P.  Schmidt,  Prior  of  the  Order  of  Charity  who,  unfor- 
tunately, died  in  1882  before  seeing  the  realization  of  his  hopes,  and 
the  institution  opened  later,  appears  to  be  mainly  custodial. 

The  reports  from  Hungary  recall  the  conditions  that  appealed  so 
forcibly  to  Guggenbiihl,  "  wretches  tramping  in  rags  and  filth, 
covered  with  vermin,  objects  of  scorn  and  aversion,  soliciting  alms 
with  grotesque  gestures." 

Switzerland,  like  France,  after  giving  an  impulse  to  other  coun- 
tries, remained  herself  with  pulses  but  little  quickened,  until  in  1883, 
Regensberg,  Canton  Zurich,  emulating  the  German  institutions, 
made  a  fresh  pathway  back  to  the  teachings  of  her  Abendberg. 
Previous  to  this,  the  work  in  the  various  cantons  consisted  chiefly 
of  erecting  asylum  or  hospital  stations ;  4  small  private  asylums  and 
1  large  establishment,  under  the  patronage  of  the  Public  Utility 
Society,  are  mentioned.  These,  however,  proved  wholly  inadequate, 
as  the  statistics  of  1897  show  mental  defectives  numbering  7,667; 
of  these,  6,215  are  of  pronounced  intellectual  inferiority,  the  re- 
mainder being  idiots.  In  1899  M.  Schenker,  of  d'Aaran,  in  a  paper 
on  the  "  Etiology  and  Therapeutics  of  Idiocy,"  pleaded  the  neces- 
sity for  legislation  to  combat  the  increase  of  imbecility.  In  this 
paper  he  pointed  out  the  necessity  of :  "  Laws  interdicting  marriage 
between  the  weak-minded,  epileptics,  and  idiots,  those  affected  by 


Plate  VI 


HISTORY.  53 

chronic  alcoholism  and  tuberculosis  ;  rational  education  and  healthful 
alimentation  for  our  youth ;  the  diffusion  of  information,  both  by 
speeches  and  through  the  press,  as  to  the  causes  of  idiocy  and  the 
means  of  combating  it;  special  classes  and  asylums  for  incurable 
idiots." 

In  1902  Switzerland  stands  possessed  of  18  asylums,  all  private, 
some  few  of  which  receive  state  appropriations,  and  41  auxiliary 
classes  in  the  various  towns.  Of  these  Zurich  counts  the  greatest 
number,  9 ;  Bale,  8 ;  Berne,  4 ;  Berthonel,  2 ;  Appenzell,  4 ;  St.  Gall, 
3 ;  Geneva,  5  ;  Wintherthom,  2.  The  special  classes  have  an  attend- 
ance of  567  children;  411  are  in  asylums,  and  114  are  in  orphan 
asylums.  There  remain  5,485  mental  defectives  for  whom  nothing 
is  being  done. 

Belgium  seems  to  have  taken  no  part  in  the  movement  so  general 
in  the  middle  of  the  nineteenth  century  to  succor  the  feeble-minded, 
the  law  leaving  entirely  to  charity  the  care  of  these  unfortunates 
who  were  often  as  utterly  neglected  as  had  been  the  mutes  and  the 
blind  of  the  preceding  century.  Judging  from  the  number  of  im- 
becile and  idiot  paupers  thronging  the  streets  soliciting  alms,  there 
must  have  been  many  thousands  of  such  children  receiving  no  man- 
ner of  education  or  training.  They  were  crowded  into  almshouses, 
houses  of  refuge,  asylums  or  in  hospitals  for  the  insane.  Statistics 
prove  that  of  those  applying  for  admission  to  institutions  for  deaf- 
mutes,  at  least  10  per  cent,  were  mentally  defective. 

At  Manage  in  Hainault  there  was  opened  by  some  Brothers  of 
Charity  in  1892,  an  asylum  for  idiots  and  epileptics,  which  reports 
in  1900  a  register  of  270  children,  60  of  whom  are  epileptic.  These, 
divided  into  three  classes,  improvables,  non-improvables,  and  crip- 
ples, receive  little  more  than  asylum  care.  There  is  a  school  in 
which  50  children  of  various  grades  of  imbecility  are  all  under  one 
teacher.  There  is  neither  manual,  musical,  nor  physical  training, 
nor  any  attempt  at  education  of  the  senses,  and  while  some  few  of 
the  brighter  children  work  in  the  shoe  and  tailor  shops,  none  of  them 
are  employed  on  the  farm. 

In  the  asylum  of  Tessenderloo,  Limbourg,  with  a  capacity  of 
200,  opened  under  similar  management  in  the  autumn  of  1895,  much 


54  HISTORY. 

the  same  conditions  exist  as  to  schools  and  lack  of  facilities  for  train- 
ing on  scientific  lines,  but  there  is  some  industrial  and  manual  train- 
ing, a  number  of  the  children  being  employed  on  the  farm,  in  the 
laundry,  and  in  tailoring,  shoe-making  and  brush-making. 

Reves,  Hainault,  a  private  institution  for  imbecile  and  backward 
children  established  also  in  1895,  and  conducted  by  some  Sisters  of 
Charity,  is  in  closer  accord  with  modern  ideas.  Epileptics  are  not 
received.  The  children  are  divided  into  five  grades  according  to 
intelligence  and  capacity,  an  average  of  eight  pupils  to  one  teacher 
giving  opportunity  for  individual  attention,  special  cases  being  often 
assigned  singly  to  one  instructor.  The  education  of  the  senses,  and 
physical,  musical  and  manual  training  make  up  the  daily  program. 

At  Saint  Ferdinand,  an  institution  directed  by  a  brotherhood  for 
the  benefit  of  children  who  have  remained  a  term  in  a  reform  school, 
the  medico-pedagogic  methods  must  be  absolutely  unknown,  for  the 
director  reports :  "  Among  these  children  coming  to  us  are  many 
who  are  backward,  imbecile,  and  epileptic;  these  naturally  are  not 
able  to  profit  by  the  instruction  given  in  the  classes  nor  will  they 
ever  be  able  to  learn  a  trade." 

La  Maison  St.  Benoit,  Lokeren,  an  asylum  for  young  girls,  idiot 
or  insane,  under  the  direction  of  Sisters  of  Charity,  numbers  365 
pupils.  These  are  divided  into  three  groups :  first  the  idiots  and 
imbeciles  classed  in  three  grades  according  to  nervous  condition; 
second,  epileptics  entirely  separated  from  other  children;  third,  crip- 
ples. Although  the  teaching  force  is  insufficient  this  is  in  a  measure 
supplied  by  many  excellent  devices  in  methods.  There  is  some  train- 
ing in  household  occupations  and  in  sewing,  but  there  is  no  regular 
methodical  correction  of  speech  defect  nor  indeed  of  any  special 
physical  weakness,  further  than  a  class  in  gymnastics. 

In  the  large  hospital  for  the  insane,  Guislain,  Ghent,  conducted  by 
Brothers  of  Charity,  there  is  a  department  for  mental  defectives 
divided  into  two  sections.  The  first  accommodates  some  25  cripples ; 
in  the  other  some  50  imbeciles  of  all  grades  are  crowded  into  a  school 
with  one  teacher  where  tuition  in  the  three  "  R's  "  only  is  attempted. 
The  education  of  the  senses  is  totally  neglected.  The  brighter  chil- 
dren have  instruction  in  music,  and  are  also  employed  about  the  farm 
and  in  the  various  shops.     As  there  is  but  one  physician  in  all  this 


HISTORY. 


55 


large  establishment  it  goes  without  saying,  that  it  is  impossible  to 
give  to  the  individual  that  psycho-physiologic  treatment  so  necessary. 

Doctors  Ingels,  Morel,  and  Demoor,  have  in  successive  years 
vainly  attempted  to  modify  the  system  and  to  introduce  reforms, 
but  the  administration  evidently  considers  the  department  for  idiots 
of  very  minor  importance.  At  Royghen,  Ghent,  seven  or  eight 
imbecile  children  of  the  wealthy  class,  receive  asylum  care  in  an  insti- 
tution for  deaf-mutes. 

In  the  two  colonies  for  the  insane,  Gheel  and  Lierneux,  there  are 
large  numbers  of  mental  defectives.  These  receive  no  special  train- 
ing and  but  few  are  employed  in  the  work  of  the  colonies,  so  that  it 
is  quite  remarkable  how  many  do  attain  to  a  certain  degree  of  useful- 
ness. Brussels  and  Antwerp  have  each  a  school  for  backward  chil- 
dren established  respectively  in  1897  and  1899,  under  the  direction  of 
the  Commissioners  of  Public  Instruction  on  medico-pedagogic  lines, 
each  having  its  examining  physician  and  provision  for  physical  and 
mental  training. 

The  children  coming  into  these  schools  are  divided  into  two 
classes,  the  merely  backward  and  the  incorrigible ;  the  one  requiring 
a  mild  and  the  other  a  severe  discipline. 

Besides  the  service  rendered  to  the  cause  of  the  mental  defective 
and  to  general  education,  these  schools  promise  an  important  field 
for  the  study  of  abnormality  and  pedology.  An  interest  is  also 
awakened  in  the  mind  of  the  general  public  favorable  to  the  views 
recently  formulated  by  the  society  for  the  treatment  of  mental  dis- 
ease :  viz.,  that  colonies  be  provided  with  asylum  schools ;  that  these 
schools  have  classes  according  to  degrees  of  intelligence;  that  the 
half-day  system  be  applied — the  children  working  largely  in  the 
open  fields;  that  children  be  received  at  a  very  early  age  as  soon  as 
a  diagnosis  is  possible;  and  that  provision  for  epileptics  be  entirely 
separate  from  others. 

It  is  almost  impossible,  even  with  the  official  and  non-official 
statistics  at  hand,  to  reach  with  any  precision  a  correct  total  of  the 
mentally  defective  population  of  Italy.  The  approximate  number 
of  24,000  includes  not  only  idiots,  imbeciles,  and  neurasthenics,  but 
all  forms  and  every  degree  of  degeneration,  intellectual  and  moral. 
Of  these,  about  1,000  only  are  cared  for  in  asylums  and  special 
classes. 


56  HISTORY. 

Following  the  example  of  Guggenbuhl's  school  in  Switzerland,  an 
attempt  was  made  in  1848  to  found  an  institution  at  Aosta,  but  this 
unfortunately  was  early  transformed  into  an  ordinary  hospital. 

To  Professor  Antonio  Gonnelli-Cioni  is  due  the  honor  of  having 
founded  the  first  school  for  mental  defectives  in  Italy.  This  he  did 
in  the  face  of  many  difficulties  and  with  small  means. 

This  school  was  established  at  Chiavari  in  1889,  and  was  later 
transferred  to  Vercurago,  Province  of  Bergamo,  where,  on  the  banks 
of  Lake  Lecco,  it  possesses  an  environment  that  is  at  once  pictur- 
esque and  healthful.  Here  in  six  years  its  numbers  increased 
from  14  to  40,  including  children  of  the  wealthier  classes  and 
others  supported  by  municipal  and  charitable  associations ;  epileptics 
are  also  received.  The  methods  are  on  medico-pedagogic  lines; 
special  attention  is  given  to  the  securing  of  a  good  physique  by 
means  of  baths  and  gymnastic  exercises.  In  addition  to  primary 
studies,  there  are  classes  in  drawing  and  designing,  in  music  and  in 
manual  training.  It  lacks  only  work-shops  for  the  arts  and  trades 
and  facilities  for  training  in  practical  agriculture. 

At  Milan  an  effort  was  made  to  form  classes  for  mental  defectives 
in  the  asylum  for  deaf-mutes  opened  1889,  and  in  Alexandria  a 
similar  experiment  was  inaugurated  the  same  year.  In  1891,  a 
school  for  nervous  children  of  the  wealthier  class  was  opened  at 
Nervi  by  Morselli ;  this  is  now  closed.  In  the  same  year  efforts  were 
made  for  the  training  of  imbeciles  in  one  of  the  largest  asylums  for 
the  insane  and  in  the  schools  of  Rome,  Sienna,  and  Reggio-Emilia. 

A  private  school  for  backward  children  was  opened  in  Milan  in 
1894  by  Signora  Segatelli. 

In  January,  1898,  Dr.  De  Sanctis,  aided  by  some  charitable  women, 
opened  an  asylum  for  backward  children  in  Rome.  In  the  same 
year  the  director  of  the  Insane  Asylum,  M.  Bonfigli,  lectured  in 
favor  of  education  for  mental  defectives,  and  for  backward  children 
in  particular.  This  was  the  initiative  of  a  movement  which  soon  ex- 
tended through  all  Italy.  Bonfigli  was  successful  in  promoting  a 
provisory  committee  that  was  soon  resolved  into  a  national  league 
for  the  protection  of  backward  children,  occupying  itself  with  the 
moral  and  intellectual  education  of  mental  defectives  adjudged  in- 
curable, and  also  in  instituting  special  classes  in  the  public  schools  for 


Plate  VIM. 


m 

k 

1      ».  -^  ^s^Km  v^B 

HISTORY.  57 

the  instruction  of  backward  children  incapable  of  receiving  benefit 
from  ordinary  methods.  It  further  advocated  the  founding-  in  Rome 
of  a  national  school  for  mental  defectives  and  converting  some  of 
the  primary  schools  into  boarding  schools  for  backward  children. 
The  views  of  Professor  Bonfigli  won  the  favorable  consideration  of 
the  Minister  of  Education,  Signor  Baccelli,  who,  in  his  report  of 
1899,  gives  the  following  endorsement:  "The  aim  of  the  league  is 
in  the  highest  degree  worthy  of  a  civilized  country,  since  in  seeking 
to  bridge  a  hiatus  in  pedagogic  methods,  and  to  complete  our  series 
of  educational  institutions,  it  proposes  to  extend  the  benefits  of  edu- 
cation to  feeble-minded  children  and  thus  to  protect  society  from 
the  menace  which  the  presence  of  so  large  a  number  of  irresponsibles 
forming  an  element  at  once  burdensome  and  dangerous  cannot  fail 
to  present." 

The  work  of  the  national  league,  enjoying  the  patronage  of  the 
Minister  of  Education,  has  been  aided  by  a  course  of  special  lectures 
given  by  Signorina  Montessori  in  the  principal  Italian  towns,  which 
have  aroused  the  liveliest  interest  in  these  unfortunates.  At  the 
same  time,  in  different  parts  of  the  kingdom,  committees  have  been 
organized,  notably  the  Emilien  and  the  Tuscan,  as  well  as  those  of 
Milan  and  Genoa.  This  last  has  recently  opened  a  special  school 
for  backward  children  as  an  annex  to  the  school  for  cripples. 

The  Emilien  Committee  owes  its  existence  largely  to  the  efforts 
of  Professor  Tamburini,  of  the  University  of  Bologna  and  Director 
of  the  Asylum  for  the  Insane  in  Reggio-Emilia,  whose  pen  has  in- 
fluenced in  no  slight  degree  the  movement  in  Italy.  This  Committee 
founded,  July,  1899,  the  institution  of  Saint-John-Persiceto,  a  medico- 
pedagogic  school,  the  most  complete  in  all  Italy.  There  are  class- 
rooms for  special  grades,  work-shops  for  the  arts  and  trades,  a 
farm  for  training  in  agriculture,  a  theatre,  music  and  drill-halls,  a 
gymnasium,  and  a  section  of  hydro-therapeutics.  There  are  also 
separate  sections  for  boys  and  for  girls,  for  the  rich  and  for  the 
poor.  Backward  children  are  received  between  the  ages  of  5  and  15, 
and  imbeciles  if  improvable,  older.  They  send  to  this  school  train- 
able imbeciles  from  the  houses  of  refuge  in  the  various  provinces, 
the  expenses  being  defrayed  by  the  province  from  which  they  come. 

The  Tuscan   School,  inaugurated  by  the  Tuscan   Committee  at 


58  HISTORY. 

Settignano,  near  Florence,  receives  as  boarders  boys  only,  from  4 
to  12  years,  but  day  pupils  of  both  sexes  from  6  to  16  years.  Only 
trainable  children  are  admitted,  those  capable  of  following  the  ele- 
mentary classes  in  the  school  and  of  being  prepared,  through  the 
medium  of  handicrafts,  to  contribute  something  to  community  or  to 
family  life. 

In  this  brief  review  we  may  note  that  although  Italy's  awakening 
to  the  claims  of  her  defective  children  has  been  tardy  in  comparison 
with  other  countries,  yet  much  has  been  accomplished  in  a  single 
decade.  A  good  foundation  seems  to  have  been  laid  in  many  direc- 
tions and  on  scientific  lines,  under  competent  and  enthusiastic  leaders, 
the  men  interested  being  of  that  position,  knowledge  and  experience 
calculated  to  insure  success. 

In  England,  in  1843,  the  articles  of  Dr.  William  Twining  called 
the  attention  of  his  countrymen  to  the  work  being  accomplished  at 
the  Abendberg,  and  the  writings  of  Mr.  Gaskell  and  Dr.  Conolly 
aroused  an  equal  interest  in  that  of  the  Bicetre.  As  the  times 
thus  ripened  laborers  were  found  ready  for  the  field.  The  Misses 
White,  in  1846,  opened  their  private  school  at  Bath,  and  the  Rev. 
Andrew  Reed,  who  in  the  midst  of  his  work  for  orphans  had 
found  time  to  study  also  the  needs  of  defectives,  journeyed  to 
Paris,  Berlin,  and  to  the  Abendberg  in  1847,  ^or  observation 
and  conference.  On  his  return,  at  a  meeting,  on  October  7, 
at  which  the  Lord  Mayor  of  London  presided,  he  was  so  success- 
ful in  enlisting  the  sympathies  of  many  that  a  committee  was  ap- 
pointed to  consider  ways  and  means  for  practical  work.  The 
following  April,  1848,  Park  House,  Highgate,  was  opened  as  a  tem- 
porary home  with  27  children.  This  family  rapidly  increased  to  50 
when  having  outgrown  its  limits,  in  1850,  the  generous  offer  of 
Essex  Hall,  near  Colchester,  made  by  Sir  Samuel  Morton  Peto,  was 
accepted,  and  the  building  renovated,  was  occupied  pending  arrange- 
ments for  securing  a  permanent  location  which  would  admit  of  yet 
more  extended  operations.  In  1853  the  corner-stone  of  the  present 
institution  of  Earlswood  was  laid  by  the  Prince  Consort,  who  two 
years  later  presided  at  its  formal  opening.  This,  with  a  capacity 
for  500  inmates,  not  only  more  than  fulfilled  the  hopes  of  the  asso- 


HISTORY.  59 

ciation,  but  immediately  upon  removal,  Essex  Hall  became  the  Asy- 
lum for  the  Eastern  Counties.  To  Dr.  Andrew  Reed  and  to  Dr. 
John  Conolly,  Superintendent  of  Hanwell  Insane  Asylum,  both  pro- 
moters and  acting  secretaries  of  the  enterprise  in  its  incipiency,  is 
therefore  due  in  large  measure  the  success  of  a  movement  that  re- 
sulted in  the  establishment  of  two  large  institutions  with  a  growing 
population,  numbering,  within  fifty  years,  some  850  mental  defec- 
tives. 

Dr.  Reed  closed,  at  the  age  of  seventy-four,  a  life  rich  in  good 
works.  Three  orphan  asylums,  a  retreat  for  incurables,  and  two 
institutions  for  the  feeble-minded  are  the  results,  direct  or  indirect, 
of  his  untiring  labors,  while  the  fruits  of  his  noble  example  are  to  be 
seen  in  the  establishment  of  Starcross,  Exeter,  Devon,  1864;  the 
Asylum  for  the  Western  Counties,  the  Royal  Albert  Asylum  opened 
at  Lancaster  in  1864;  and  Knowle,  opened  at  Birmingham  in  1866, 
for  the  Northern  and  Midland  Counties.  These  show,  at  the  end 
of  the  nineteenth  century,  an  aggregate  population  of  1,000  de- 
fectives. 

Since  1875  the  Metropolitan  Schools  of  Darenth,  Dartford,  Kent, 
with  a  capacity  for  1,000,  have  provided  for  successive  numbers  of 
the  pauper  class,  whereas  private  schools,  notably  those  of  Ancaster 
House,  Richmond  Hill  (Dr.  G.  E.  Shuttle  worth),  Winchester 
House,  Kingston  Hill  (Dr.  Fletcher  Beach),  and  Normansfield 
(Dr.  Langdon  Down),  respond  to  the  imperative  demands  of  the 
wealthier  classes. 

In  Scotland,  as  early  as  1819,  the  importance  of  medical  care  and 
educational  training  for  imbecile  children  was  advocated  by  Dr. 
Richard  Poole,  of  Edinburgh,  in  an  article  on  "  Education  "  in  the 
Encyclopedia  Edinensis,  reprinted  in  pamphlet  form  in  1825. 
"  There  is  reason,"  he  urges,  "  for  imagining  that  the  principle  of 
substitution,  by  which  one  faculty  or  sense  is  made  to  answer,  in 
some  degree,  for  another,  might  serve  as  the  basis  of  successful  edu- 
cation; and  that  it  is  possible  that  the  worst  cases  ever  met  with 
would  so  far  yield  to  science  and  industry  as  to  vindicate  and  reward 
the  patience  and  ingenuity  bestowed  on  them.  .  .  .  The  philosopher 
who  should  undertake  to  investigate  the  whole  subject  and  to  suggest 


60  HISTORY. 

a  suitable  plan  for  remedy  or  alleviation,  would  perform  an  accepta- 
ble service  to  science,  and  merit  the  gratitude  of  mankind." 

Sir  John  and  Lady  Jane  Ogilvy,  in  grateful  acknowledgment  of 
all  that  the  Abendberg  had  accomplished  for  their  defective  child, 
established  in  1852,  on  their  estate  at  Baldovan,  near  Dundee,  an 
institution  with  accommodations  for  30  children.  This  was  sup- 
ported by  contributions  and  by  fees  obtained  from  children  of  the 
wealthier  classes. 

A  similar  institution  opened  in  Edinburgh  in  1855,  under  the  di- 
rection of  Dr.  David  Brodie,  was  maintained  for  some  years,  until 
later  he  was  called  to  take  charge  of  the  Scottish  National  Institu- 
tion for  the  Education  of  Imbecile  Children,  designed  to  accommo- 
date 200  children.  This  latter  institution,  founded  in  1861  at  Lar- 
bert,  Stirlingshire,  will  always  be  associated  with  the  name  of  an- 
other of  its  superintendents,  Dr.  William  W.  Ireland,  who,  after  an 
exhaustive  study  of  imbecility,  made  a  large  and  valuable  contribu- 
tion to  its  bibliography,  and  now  directs  a  private  school  for  imbe- 
ciles at  Mavisbush  House,  Polton,  Midlothian. 

The  Census  Commissioners  of  Ireland  in  1861  reported  7,033 
defectives,  and  suggested  "  the  propriety  of  taking  some  steps  toward 
the  education  and  moral  improvement  of  idiots  and  imbeciles,  a 
subject  which  at  present  engages  the  attention  of  the  philanthropic, 
both  in  England  and  on  the  Continent,  where  several  establishments 
for  the  purpose  have  been  erected  and  are  supported  by  the  State; 
and  in  which  the  susceptibility  of  this  class  to  a  certain  amount  of 
education  has  been  demonstrated."  No  movement  followed  this  sug- 
gestion until  1869,  when  the  Stewart  Institution  at  Palmerston, 
Dublin,  was  opened  with  43  pupils. 

The  British  Colonial  institutions  are  as  follows : 

Canada  maintains  one  public  institution  at  Orillia,  Province  of 
Ontario,  providing  for  450  children. 

In  South  Africa,  Cape  Colony,  there  is  a  department  for  idiot  chil- 
dren in  the  Grahamstown   (Government)   Asylum. 

In  Australia,  provision  is  made  for  the  training  of  200  defectives  in 
the  Kew  Asylum  for  the  Insane,  Melbourne.  There  are  also  private 
schools  at  Moonee  Ponds,  Melbourne,  and  Adelaide.     Special  classes 


Plate  IX. 


Case  F.  Case  G. 

IDIOTS  — SUPERFICIAL  EXCITABLE. 


HISTORY.  6 1 

for  backward  children  have  also  been  opened  in  connection  with  the 
national  schools. 

Japan  has  not  been  slow  to  receive  her  impulse  from  America. 
Among'  the  many  subjects  that  her  students  have  of  late  years 
interestedly  studied,  the  training  of  mental  defectives  has  been  in- 
cluded, the  various  institutions  of  the  United  States  receiving  from 
time  to  time,  observers  eager  to  investigate  methods ;  notably,  Mr. 
Konishi,  Director  of  the  Government  School  for  the  Blind  and  Deaf- 
mutes  at  Tokyo,  and  Mr.  R.  Ishii  (Osuga),  Director  of  an  orphanage 
having  a  department  for  the  feeble-minded.  In  a  letter  but  recently 
received,  Mr.  Ishii  thus  recounts  the  steps  in  a  movement  which 
will  doubtless  lead  all  Japan : 

"  In  1890  there  took  place  at  Nagoya,  about  two  hundred  miles 
south  of  Tokyo,  a  great  earthquake  which  destroyed  about  ten  thou- 
sand lives.  Naturally,  there  were  left  a  number  of  helpless  orphans. 
So  I  gathered  some  of  those  poor  little  ones  and  opened  my  orphan- 
age. Among  them  there  was  an  imbecile  child  and  this  has  caused 
me  to  open  the  department  for  the  feeble-minded  children.  Some 
more  of  the  latter  were  added  soon  after,  and  there  live  with  me  six 
of  them  now.  A  new  building  is  just  going  to  be  finished,  and 
twenty  more  of  the  feeble-minded  are  expected  next  month.  There 
are  nearly  two  hundred  applicants,  but  I  have  no  room  for  any  addi- 
tion of  inmates.  My  institution  is  a  private  one.  My  intention  is 
to  make  an  orphanage  department — that  is  to  say,  the  normal  minded 
— as  much  self-supporting  as  possible,  and  to  devote  the  larger  por- 
tion of  the  contributions  which  come  to  us  to  the  education  of  the 
feeble-minded,  who,  in  nature  of  the  case,  must  remain  dependent  on 
the  helping  hand  of  their  more  fortunate  fellow-men." 

While  Kern  was  taking  the  initiatory  steps  in  Germany,  a  similar 
experiment  toward  broader  conclusions  was  being  made  in  the  United 
States  by  Dr.  Samuel  G.  Howe,  of  Boston,  Director  of  the  Perkins 
Institution  for  the  Blind. 

As  early  as  the  year  1839,  he  tells  us,  a  child  was  received  at  his 
institution  not  only  blind,  but  unsound  in  mind,  and  paralyzed. 
Under  a  course  of  treatment,  persisted  in  according  to  physiologic 


62  HISTORY. 

and  hygienic  laws,  its  condition  was  so  far  ameliorated  as  to  encour- 
age him  in  taking  two  similar  cases. 

Favorable  results  led  Howe  to  infer  that,  "  If  so  much  could  be 
done  for  idiots  who  were  blind,  still  more  could  be  accomplished 
for  those  who  had  sight."  Many  prominent  men  became  interested 
in  the  work,  and  in  the  winter  of  1846,  Judge  Byington,  a  member  of 
the  House  of  Delegates,  secured  the  appointment  of  a  committee  to 
inquire  into  the  condition  of  idiots  in  the  Commonwealth  of  Massa- 
chusetts. The  report  of  a  Commission,  of  which  Dr.  Howe  was 
Chairman,  showed  a  thorough  investigation  into  the  nature,  causes, 
and  various  forms  of  idiocy,  and  gave  a  full  statement  of  conditions 
and  treatment  of  514  idiots  in  various  almshouses  and  private  fami- 
lies in  Massachusetts ;  contrasted  with  what  was  being  done  for 
mental  defectives  in  the  training-schools  of  Switzerland,  Germany, 
and  France,  together  with  a  letter  from  Mr.  George  Summer,  then 
resident  in  Paris,  giving  a  full  and  detailed  account  of  the  work  at  the 
Bicetre. 

The  immediate  result  was  an  appropriation  by  the  state  of  $2,500 
annually,  for  a  term  of  three  years,  for  the  establishment  of  an  ex- 
perimental school ;  and  to  this  end  arrangements  were  made  by  the 
Governor  with  the  trustees  of  the  Perkins  Institution  for  the  Blind, 
in  order  that  the  experiment  might  be  conducted  by  Dr.  Howe  who 
had  so  ably  demonstrated  its  possibilities. 

A  competent  teacher,  Mr.  James  B.  Richards,  was  engaged  and 
sent  to  learn,  by  personal  observation,  the  methods  of  instruction 
pursued  in  Paris.  The  school  was  opened  in  October,  1848,  with  10 
state  beneficiaries  and  3  private  pupils.  At  the  expiration  of  the 
second  year,  the  success  of  the  experiment  having  been  proved, 
an  act  of  assembly  incorporated  the  Massachusetts  School  for 
Idiotic  and  Feeble-minded  Children,  and  arrangements  were  set  on 
foot  for  converting  the  experimental  school  into  a  separate  and  per- 
manent establishment  in  South  Boston. 

Necessity  demanded  that  the  school  be  separated  from  the  insti- 
tution for  the  blind.  An  equally  urgent  necessity  called  for  a  person 
to  take  charge,  one  who,  as  physician,  psychologist,  and  teacher  in 
one,  could  alone  help  to  meet  the  varied  requirements  of  the  new 
establishment  and  get  it  into  working  order.     Just  at  the  time  Dr. 


HISTORY.  63 

Howe  was  seeking  for  such  a  person  to  aid  him  in  the  difficult  task 
of  directing  two  institutions,  a  fortunate  combination  of  circum- 
stances brought  about  a  correspondence  with  Dr.  Seguin  who,  inter- 
rupted in  his  educational  and  literary  work  in  Paris,  consented  to 
come  to  him  for  a  brief  period.  Thus  it  happened  that  the  first  effort 
to  introduce  foreign  methods  of  training  mental  defectives  into 
America  should  be  organized  and  implanted  by  one  himself  largely 
the  author  of  these  methods.  This  may,  therefore,  be  reckoned  not 
the  least  important  of  the  successive  steps  taken  by  Dr.  Howe  as 
pioneer  in  a  work  that  crowns  a  life  devoted  to  the  service  of  the 
helpless. 

To  his  experiments,  his  indomitable  will,  and  his  unflagging  energy 
is  due  the  rescue  to-day,  of  the  imbecile  in  America.  His  last  re- 
port, closing  a  record  of  thirty  years,  shows  that,  after  bringing  into 
existence  the  school  in  South  Boston,  he  had  been  in  daily  attendance 
there,  giving  his  personal  supervision  to  every  detail  of  the  estab- 
lishment ;  this  in  addition  to  printed  and  personal  appeals  influencing 
the  legislatures  of  his  own  and  of  sister  states,  and  all  without 
salary  or  emolument.  The  school  remains  his  most  enduring  monu- 
ment. Removed  to  its  present  site,  Waverly,  near  Boston,  where  it 
shelters  800  children,  it  most  fittingly  celebrated  its  fiftieth  anniver- 
sary, the  close  of  the  century,  and  the  beginning  of  a  new  era  by  the 
purchase  of  1,660  acres  of  land  and  the  establishment  of  a  colony 
providing  permanent  homes  for  those  who  have  completed  their 
training. 

Not  alone  in  public,  but  in  private  work,  is  Massachusetts  the 
pioneer  of  this  cause  in  America.  It  was  at  Bar  re,  in  July,  1848, 
that  Dr.  Hervey  B.  Wilbur,  inspired  by  what  he  had  heard  of  the 
Bicetre  and  the  Hospice  des  Incurables,  made  his  small  beginning 
and  won  that  practical  experience  that  later,  in  close  and  personal 
intercourse  with  Seguin,  was  to  bear  such  splendid  fruit  at  Syracuse. 

Under  the  fostering  care  of  the  Browns,  his  immediate  successors, 
Barre  has  grown  into  a  village  of  cottages  for  incapables  of  the 
wealthier  class,  the  oldest  and  the  largest  private  institution  in 
America,  with  accommodations  for  some  100  pupils. 

New  York,  simultaneously  with  Massachusetts,  in  1846,  appointed 
a  commission  on  idiocy;  less  fortunate  than  the  latter,  however,  the 


64  HISTORY. 

plan,  upon  the  retirement  of  its  champion,  Dr.  Backus,  from  the 
senate,  failed  to  fructify.  Later  a  correspondence  with  Governor 
Hunt  led  to  an  exhibition,  in  the  capitol  at  Albany,  before  the  state 
authorities  and  many  members  of  the  legislature,  of  some  of  the 
pupils  of  the  Massachusetts  school. 

The  interest  thus  aroused,  together  with  the  impression  made  by 
the  earnest  appeal  of  Dr.  Howe,  caused  a  renewal  of  the  long-aban- 
doned attempt  to  establish  in  New  York  an  experimental  school, 
which  was  opened  in  Albany,  October,  1851,  Dr.  Hervey  B.  Wilbur 
being  called  from  the  successful  founding  of  the  Barre  Institution  to 
take  charge.  Under  his  wise  direction  such  possibilities  were  dem- 
onstrated that  it  was  deemed  expedient  to  remove  the  school  to  per- 
manent quarters  at  Syracuse,  where  was  erected  the  first  building  in 
America  for  the  specific  purpose  of  caring  for  the  feeble-minded. 

"  Dr.  Seguin  coming  to  me,"  says  Dr.  Wilbur,  "  rendering  invalu- 
able service  by  his  council,  inspired  my  assistants  with  his  enthu- 
siasm." With  two  such  leaders  success  was  assured,  and  the  insti- 
tution more  than  fulfils  its  early  promise.  At  the  present  time  it  has 
some  600  pupils ;  it  receives  no  untrainables  and  no  epileptics. 

New  York  has  made  further  provision  for  mental  defectives  in  its 
various  branches  of  public  charities,  notably  one  of  the  Randall's 
Island  Asylum  group,  organized  in  1849,  and  harboring  now  475 
children.  Under  the  efficient  management  of  Mrs.  M.  C.  Dunphey, 
trained  for  the  work  by  Dr.  Wilbur,  this  school  is  an  object-lesson 
in  the  perfection  of  that  manual  work  best  adapted  to  the  needs  of 
the  feeble-minded. 

The  New  York  State  Custodial  Asylum  at  Newark,  founded  Sep- 
tember 3,  1878,  gives  protection  and  training  to  459  of  the  brighter 
class  of  feeble-minded  women. 

The  Rome  State  Custodial  Asylum,  opened  May  1,  1894,  the 
first  in  America  for  helpless  and  unimprovable  only,  responded  to  the 
immediate  and  pressing  claims  of  adult  cases,  and  now  provides  for 
410  men  and  129  women.  Situated  at  the  entrance  of  the  Mohawk 
Valley,  with  ample  space  for  the  contemplated  improvements,  the 
capacity  of  the  institution  will  eventually  be  increased  to  1,500. 

The  Craig  Colony  for  Epileptics  at  Sonyea,  rapidly  emulating  the 
example  of  Bielefeld,  has  an  element  of  stability  in  that  it,  like  many 


HISTORY.  65 

of  the  institutions  that  we  have  mentioned,  is  a  superstructure  built 
upon  a  foundation  laid  by  others. 

Situated  in  the  beautiful  Genesee  Valley,  about  40  miles  from 
Rochester,  this  tract  of  1,900  acres,  with  some  30  substantial  build- 
ings, was  originally  the  home  of  a  busy,  thrifty  sect  of  Shakers. 
These  being  celibates,  the  colony  receiving  but  few  accessions  grad- 
ually diminished  in  numbers,  until  in  1892,  the  few  aged  members 
remaining,  sold  their  interest  to  the  state  for  the  small  sum  of 
$115,000,  this  being  but  little  more  than  the  value  of  the  buildings. 

The  present  colony  opened  on  January  20,  1896,  under  state 
patronage,  and  received  within  nine  months,  145  patients.  As  exper- 
iments aiming  at  cure  are  being  conducted,  only  the  most  favorable 
cases  are  accepted,  although  there  is  hope  that  in  the  near  future  the 
institution  may  be  opened  to  all  classes  of  epileptics. 

Its  growth  in  the  six  years  of  its  existence  is  phenomenal ;  seven 
resident  medical  officers  are  in  attendance;  there  is  a  ratio  of  one 
nurse  to  every  twelve  patients ;  schools,  farms,  and  shops  represent- 
ing all  the  various  industries  provide  occupation  for  700  patients ;  the 
colony  is,  in  fact,  an  industrial  village.  The  title  it  bears  was  sug- 
gested by  the  Governor  of  the  State  as  a  tribute  to  Oscar  Craig, 
former  President  of  the  State  Board  of  Charities,  who,  together  with 
Wm.  P.  Letchworth,  of  the  same  association,  and  Dr.  Frederick 
Peterson,  were  commissioners  engaged  in  the  selection  of  a  location 
and  are  warm  promoters  of  the  scheme. 

Pennsylvania,  like  New  York,  received  its  impetus  from  Massa- 
chusetts. In  1852  James  B.  Richards,  who  came  direct  from  his 
work  in  Boston,  opened  a  private  school  in  Germantown.  Here  he 
was  successful  in  enlisting  the  sympathies  of  Bishop  Alonzo  Potter, 
Franklin  Taylor,  and  other  prominent  citizens  of  Philadelphia,  in- 
cluding Dr.  Alfred  Elwyn  who,  during  a  visit  to  Boston  in  1849, 
had  been  an  interested  observer  of  the  work  done  there  by  Dr. 
Howe  and  Mr.  Richards.  On  February  10,  1853,  a  meeting  was 
called  for  discussion,  and  a  corporation  then  and  there  formed,  that 
with  a  Board  of  Directors  undertook  the  responsibility  of  the  work, 
retaining  Mr.  Richards  as  teacher  in  charge.  An  exhibit  made  by 
him  of  the  children  and  their  work  before  the  legislature  at  Harris- 
5 


66  HISTORY. 

burg,  in  the  winter  of  1854,  resulted  in  an  appropriation  from  the 
state  of  $10,000  and  provision  for  10  beneficiaries. 

In  1855  property  was  purchased  on  Woodbine  Avenue,  to  which 
the  school  of  17  children  was  removed.  In  the  following  year 
(1856),  Dr.  Seguin  became  associated  in  its  direction,  and  the 
enterprise  seemed  fairly  and  successfully  launched;  but  dissensions 
coupled  with  financial  embarrassment  soon  arose  and,  with  the  retire- 
ment of  both  Seguin  and  Richards  disaster  threatened;  this,  how- 
ever, was  fortunately  averted  by  the  appointemnt  of  Dr.  Joseph 
Parrish,  under  whose  wise  management  difficulties  were  tided  over, 
differences  adjusted,  and  embarrassments  relieved.  Recognition, 
public  and  private,  in  the  form  of  appropriations,  donations,  and 
legacies,  soon  gave  such  guarantee  of  stability  as  to  warrant  a 
removal  of  the  school  to  its  present  site  at  Elwyn,  within  fifteen 
miles  of  Philadelphia.  This  location  was  selected  by  Miss  Dorothea 
L.  Dix  and  Mr.  H.  Jones  Brooke  as  affording  greater  opportunity  for 
expansion  and  for  the  founding  of  a  permanent  institution ;  and  in 
December,  1857,  the  corner-stone  of  the  main  building  "  dedicated 
forever  to  the  shelter,  instruction,  and  improvement  of  God's  most 
afflicted  children  "  was  laid  by  Bishop  Potter,  the  President  of  the 
Board. 

On  September  1,  1859,  the  school  of  25  children,  with  goods  and 
chattels,  teachers  and  attendants  came  to  take  possession,  and  to 
establish  among  the  many  discomforts  incident  to  the  situation  the 
present  asylum  village  of  Elwyn. 

Of  Dr.  Parrish  it  has  been  truly  said :  "  Never  was  a  man  better 
adapted  to  leading  and  vitalizing  a  forlorn  hope."  Through  all  the 
difficulties  and  discomforts  consequent  upon  the  selection  of  a  new 
location,  of  building,  of  removal,  of  wintering  in  quarters  still  un- 
completed, and,  therefore,  lacking  much-needed  appliances,  his  office 
was  truly  to  warn,  to  comfort,  and  to  command,  and  while  outlining 
and  shaping  future  possibilities,  to  give  generous  sympathy  and  to 
make  provision  for  present  needs.  All  this  he  accomplished  under 
financial  straits  that  the  shadow  of  approaching  civil  strife  but  inten- 
sified. Well  might  he  feel  an  honest  pride,  when,  on  retiring  from 
the  work  in  1864,  after  eight  years'  service,  he  left  it  "  complete  in  its 
organization,  with  a  name  and  prestige  all  that  might  be  desired  as 


HISTORY.  6? 

an  earnest  of  permanent  success."  As  his  biographer  so  aptly  puts 
it :  "  The  keynote  of  his  life  was  a  sympathy  that  uplifts  without  pau- 
perizing its  object,  the  moving  principle  common  sense  in  an  uncom- 
mon degree,  the  two  combined  giving  a  fair  working  definition  of 
genius." 

Truly  to  this  man  the  Pennsylvania  Training  School  owes  a  double 
debt :  not  only  was  it  his  to  rescue  and  "  strengthen  such  things  as 
remain,"  but  in  the  careful  training  of  "  a  son  in  the  profession  "  to 
build  up  within  the  structure  itself  that  which  was  to  prove  its  very 
tower  of  strength.  It  was,  therefore,  simply  an  act  of  approval  of 
this  his  crowning  work,  when  the  Board  nominated  his  assistant,  Dr. 
Isaac  N.  Kerlin,  as  the  only  man  fitted  to  succeed  him,  recognizing 
in  him  ability  and  capacity  for  extending  and  elaborating,  as  growth 
should  indicate,  plans  into  which  he  had  grown  and  of  which  he  had 
actually  become  a  part. 

The  first  in  America  to  receive  in  this  specialty  a  training  so  com- 
prehensive and  so  continuous,  all  his  splendid  powers  heightened  and 
vivified  by  an  intense  enthusiasm  for  the  cause  that  appealed  to  the 
depths  of  a  nature  tender  and  sympathetic  as  a  woman's ;  Dr.  Kerlin 
brought  to  the  work  to  which  he  was  to  consecrate  the  best  years  of 
his  life  a  power  that  was  almost  mesmeric,  and  that  controlled 
absolutely  all  who  came  within  its  influence.  Children,  attendants, 
officers,  friends,  visitors,  the  most  careless,  the  most  indifferent, 
testified  to  this  undefined  "  something  "  to  which  all  yielded  and  that 
made  itself  felt  equally  within  institution  walls  as  in  legislative  halls. 
With  infinite  faith  in  the  cause  itself  and  in  himself  as  its  champion, 
his  persistence  in  the  prosecution  of  an  enterprise  once  entered  upon 
defied  defeat.  In  periods  of  patient  waiting  he  was,  nevertheless, 
equally  strong,  secure  in  the  belief  of  that  which  was  sure  to  come. 
So  we  find  him  in  the  first  few  years  of  his  superintendency,  in  that 
most  trying  period  at  the  close  of  the  Civil  War,  bending  his  energies 
to  domestic  economies  and  the  perfecting  of  the  internal  arrange- 
ments of  the  household ;  each  department  receiving  his  careful  and 
personal  attention,  as  he  gradually  enlarged  its  sphere  and  scope 
until  the  inner  needs  actually  conditioned  the  outer  extension.  Thus 
the  improvements  long  predetermined  by  his  predecessor  were  out- 
lined and  detailed  under  his  prescient  eye  as  the  result  of  practical 


68  HISTORY. 

experience  and  natural  growth.  When  the  times  were  ripe,  the  case 
was  presented  in  a  manner  so  convincing  that  neither  legislators  nor 
private  patrons  could  withstand  his  appeal ;  the  legislature,  by  re- 
peated appropriations,  aided  in  the  erection  of  new  buildings,  and 
bequests  and  donations  from  time  to  time  testified  to  the  growing 
interest  of  an  appreciative  public. 

The  recognition  of  the  moral  imbecile,  and  the  absolute  necessity 
of  a  life-long  guardianship,  protection  against  temptation,  and  all 
the  horrors  of  criminal  procedure  of  which  he  must  be  but  the 
innocent  victim,  were  long  and  strenuously  insisted  upon  by  Dr. 
Kerlin  in  the  name  of  science,  of  sociology,  as  a  matter  of  political 
economy,  of  the  protection  of  homes,  and  all  that  man  holds  dear. 
Through  the  press,  on  the  platform,  in  his  official  reports  as  in 
private  conversations,  he  did  not  cease  to  press  home  this  truth,  that 
a  truly  healthful  status  of  the  nation  depends  upon  eliminating  from 
its  arteries  this  most  pernicious  element  and  to  point  out  this  the  only 
feasible  plan ;  the  gathering  of  these  unfortunates  into  homes  under 
the  care  of  specialists,  where  trained  to  habits  of  self-support,  pro- 
tected from  the  world  and  the  world  from  them,  they  might  live  out 
their  brief  day,  unharmed  by  ignominy  and  the  thousand  ills  the 
world  would  bring. 

More  fortunate  than  many  promoters  of  a  cause,  he  lived  to  see  his 
views  entertained  and  acted  upon  by  many.  Both  judges  and  prose- 
cuting attorneys  soon  began  to  recognize  a  certain  irresponsibility 
and  natural  predisposition  to  crime.  Thus,  he  claims  that  applica- 
tions for  admission  of  defectives  of  this  character  increased  so  rapidly 
from  1884  to  1889  as  to  threaten  embarrassment  to  the  work  of 
training,  and  in  1892  he  calls  attention  to  the  difference,  distinctly 
observable,  between  our  own  and  foreign  institutions,  that  is  brought 
about  by  the  absence,  in  the  latter,  of  this  disturbing  element. 

An  exhaustive  report  of  a  tour  of  investigation,  made  to  the 
National  Association,  forms  the  last  of  his  many  valuable  contribu- 
tions to  the  literature  of  the  work.  The  closing  year  of  his  life  was 
marked  by  active  measures  in  behalf  of  the  Western  Pennsylvania 
Institution,  and  the  perfection  of  an  exhibit  for  the  World's  Fair 
at  Chicago.  His  last  report  sounds  a  clear  note  of  warning  against 
the  excessive  growth  of  the  asylum  department,  which  "  unless  vigi- 


Plate  X. 


L 

Buy 

*±am 

!  ''         * 

HISTORY.  69 

lance  and  interest  in  the  training  department  be  maintained,  will 
eventually  greatly  weaken  its  influence  and  usefulness."  He  also 
urges  separate  provision  for  children  of  the  wealthier  classes,  and  a 
further  extension  in  the  erection  of  small  cottages  for  isolation  and 
classification ;  "  under  which  growth  and  development,"  he  says, 
"  Elwyn  will  soon  become  a  perfect  organization  for  the  many  forms 
and  protean  demands  of  a  thousand  feeble-minded  folk." 

With  this  word  of  prophecy  he  rests  from  his  labors,  dying  Oc- 
tober 25,  1893.  His  tomb  marks  one  of  the  most  beautiful  sites  in 
the  park,  so  that  even  in  death  he  is  in  the  midst  of  the  life  of  child- 
hood of  which,  for  thirty  years,  he  had  been  the  watchful  guardian. 

It  is  interesting  to  note  how  Elwyn  has  fulfilled  his  hopes  and 
aims.  Farm  and  park  lands  now  embrace  337  acres.  Its  buildings 
increasing  from  year  to  year  to  the  number  of  27,  have  all  modern 
appliances  and  the  necessary  fittings  of  some  20  schools  and  trade- 
shops,  a  theatre  and  music  rooms,  a  gymnasium  and  drill-hall,  well 
equipped  laboratories — anthropometric  and  bacteriologic — and  two 
hospitals.  Its  trainable  children  gradually  but  steadily  outnumbering 
its  untrainable,  include  those  of  the  wealthier  class  from  the  States, 
and  also  from  Austria,  Germany,  England,  Brazil,  the  West  Indies 
and  Japan.  Not  only  was  the  thousand  mark  easily  attained,  but 
after  sending  out  a  colony  of  trained  workers  to  build  up  and 
strengthen  the  western  institution,  its  population  in  its  fiftieth  year 
outnumbered  that  of  any  previous  year. 

The  opening  of  the  splendidly  equipped  institution  for  Western 
Pennsylvania  at  Polk,  Venango  County,  April  21,  1897,  marks  the 
first  independent  action  of  the  state  toward  mothering  her  feeble- 
minded children.  To  this  institution  were  transferred  154  of  those 
trained  at  Elwyn,  so  that  beginning  with  the  experience  derived  from 
a  parent  institution,  and  having  the  advantage  of  trained  workers 
and  every  modern  appliance  provided  by  the  fostering  care  of  the 
state,  its  prosperity  and  rapid  advance  in  population  within  7  years 
to  nearly  900  children,  were  almost  foregone  conclusions. 

Ohio,  which  has  surpassed  all  pioneer  states  in  liberal  and  gener- 
ous provision  for  mental  defectives,  followed  close  upon  New  York 
in  the  establishment  of  an  institution  at  Columbus,  April  17,  1857. 
This  institution  also  felt  the  energizing  touch  of  Dr.  Seguin's  hand, 


70  HISTORY. 

and  Dr.  Doren,  during  a  superintendency  of  over  thirty  years,  has 
seen  its  population  more  than  once  pass  the  thousand  mark. 

In  Connecticut  a  State  Commission  appointed  in  1855,  to  investi- 
gate existing  conditions  of  defectives,  met  with  a  settled  conviction 
among  the  majority  of  its  citizens  that,  "  their  work  was  a  waste 
of  time."  Nevertheless,  in  1858,  a  school,  opened  at  Lakeville  by 
Dr.  Henry  M.  Knight,  appeared  to  meet  a  demand,  for  it  received  aid 
through  both  public  and  private  donations,  and  enjoys,  in  addition, 
a  large  private  patronage. 

The  example  set  by  these  pioneers  was  followed  with  more  or  less 
readiness,  until  the  opening  of  the  twentieth  century  saw  21  states 
from  ocean  to  ocean,  each  providing  at  least  one  institution,  while 
private  schools  and  special  classes  have  multiplied,  so  that  of  the 
number  of  mental  defectives  in  the  United  States,  broadly  computed 
at  100,000,  at  least  one-tenth  are  now  receiving  some  degree  of  care. 
In  addition,  the  attention  of  the  public  is  constantly  aroused  to  the 
necessity  for  the  segregation  and  permanent  sequestration  of  these 
unfortunates,  as  conducive  alike  to  their  own  and  to  the  public 
welfare. 

New  Jersey  for  many  years  depended  upon  Pennsylvania  for  the 
training  of  her  feeble-minded  beneficiaries.  Although  among  the 
latest  in  the  field,  she  holds,  in  the  Seguin  School  at  Orange,  the 
seal  to  the  lifework  of  the  great  progenitor  of  the  entire  system. 
This  school,  opened  by  Dr.  Seguin  in  New  York  City  a  few  years 
prior  to  his  death,  was  in  1894  removed  by  his  widow  to  Orange, 
where,  with  1 1  teachers,  it  maintains  its  limit  of  25  pupils,  and  stands 
foremost  among  the  private  enterprises  of  its  kind  in  the  country. 

To  the  Garrison  family  is  due  the  successful  inauguration  of  the 
work  along  broader  lines.  Between  the  years  1845  and  1850,  coeval 
with  the  effort  in  New  York,  Stephen  Garrison,  of  Millville,  re- 
peatedly and  persistently  urged  the  duty  of  state  provision  upon  the 
legislature,  of  which  he  was  a  member.  Although  his  appeals  were 
ineffectual,  disappointment  did  not  include  failure.  The  seed  sown 
by  him  was  nurtured  and  garnered  by  his  two  sons  who,  in  1887, 
turned  their  family  homestead  in  Millville  into  a  private  school  for 
mental  defectives.  This  soon  outgrew  accommodations  and  a 
change  was  deemed  expedient.     Charles  Garrison  then  removed  to 


HISTORY.  71 

Cranberry,  where  he  continued  for  some  years  a  school  of  a  dozen 
pupils.  His  brother,  Olin  S.  Garrison,  seeking  a  wider  field,  came 
with  his  family  and  seven  pupils  to  Vineland.  Here  he  succeeded 
in  founding  an  association  that  laid  broad  the  foundation  of  the  pres- 
ent training-school,  and  later  influenced  the  creation  by  the  state, 
of  a  protective  asylum  and  school  for  women.  Thus  do  the  twin 
institutions  of  Vineland  owe  their  existence  largely  to  one  who, 
superintendent  of  each  in  turn,  saw  them  rise  from  small  beginnings 
to  well-appointed  institutions,  enjoying  both  public  and  private 
patronage. 

Following  the  experiments  worked  out  in  the  continental  cities  and 
in  England,  the  special  classes  for  backward  children  opened  first 
in  Providence,  Rhode  Island,  and  now  part  of  the  educational  sys- 
tem of  New  York,  Philadelphia,  Chicago,  and  Boston,  are  a 
powerful  agent  in  this  work;  not  only  in  enlightening  the  public  as 
to  the  character  of  the  evil  in  its  midst,  but,  by  demonstrating  certain 
phases  of  imbecility,  removing  the  obloquy  of  idiocy  from  those  who 
may  be  benefited  by  training. 

In  the  foregoing  historical  sketch  only  the  principal  institutions  for 
mental  defectives  in  the  various  countries  have  been  touched  upon, 
but  the  titles  of  all,  as  complete  as  possible  from  data  obtainable, 
may  be  found  in  the  subjoined  list. 

France. 

Bicetre,  Paris.     Department  for  feeble-minded  and  epileptics. 
Salpetriere.     Department  for  feeble-minded  and  epileptics. 
LTnstitut  Medico-Pedagogique,  Vitry-Sur-seine.     For  backward 
children. 

La  Force  near  Bordeaux.     Colony  for  epileptics. 

Germany. 

Dalldorf  near  Berlin.     For  idiots. 
Hubertusburg,  Saxony.     For  feeble-minded. 
Neu-Erkerode,  Braunschweig.     For  feeble-minded. 
Kuckenmiihle,   Stettin-Griinhof,  Pomerania.      For  feeble-minded 
and  epileptics. 

Tabor.     For  epileptics  only. 

Langenhangen,  Hanover.     For  feeble-minded  and  epileptics. 


72  HISTORY. 

Mariaberg,  Wiirtemberg.     For  feeble-minded. 

Mockern,  Saxony.     For  feeble-minded. 

Nienstedt  on  the  Harz,  Saxony.     For  feeble-minded  and  epileptics. 

Stetten,  Remsthal,  Wiirtemberg.    For  feeble-minded  and  epileptics. 

Bethel  near  Bielefeld,  Westphalia.     For  epileptics  only. 

Rothenburg.     For  epileptics  only. 

Neuendettelsau.     For  feeble-minded  and  epileptics. 

Polsingen.     For  feeble-minded  and  epileptics. 

Alsterdorf  near  Hamburg.  For  feeble-minded,  epileptics,  crip- 
ples, etc. 

Diisseldorf  near  Gladbach.     For  feeble-minded. 

Hochschweitzen,   Saxony.     For  epileptics. 

Alice-stift  near  Darmstadt.     For  feeble-minded  and  epileptics. 

Grosshennersdorf,  Saxony.     For  feeble-minded. 

Freiburg  in  Silesia.     For  feeble-minded  and  epileptics. 

Scheuern  near  Nassau  on  the  Lahn.     For  idiots. 

Westphalia,  Niedermarsberg  Institutions.  For  feeble-minded  and 
epileptics. 

Dresden,  Oppelstrasse,  44/44-B.     For  feeble-minded. 

Ostbahn,  Diihlgarten  Biesdorf.     For  epileptics. 

Berlin.     Municipal  Institute   for  epileptics. 

Denmark. 

Gamle  Bakkehus,  near  Copenhagen. 

Ebberodgaard. 

Lillemosegaard. 

Karens  Minde. 

Keller  Institutions,  Copenhagen  and  Brejning  (Jylland). 

Jutland. 

Institution  for  Idiotic  Children. 

Sweden. 

The  School  of  the  Society  for  the  Care  of  Feeble-Minded  Children, 
Stockholm. 

Working  Home  for  Idiot  Men,  Rickomberga,  Upsala. 


Pl/>te  XI 


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■!■■  1  Mil            1— 1       1 

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HISTORY.  73 

Working  Home  for  Female  Idiots,  Stockholm. 

Institution  for  Idiots,  Sofielund,  Stromsholm. 

Institution  for  Idiots,  Johannesberg,  Mariestad. 

Hogelid  Asylum  for  Feeble-Minded  Children,  Mariestad. 

Sodermanlands  Lans  Institution  for  Idiots,  Strangnas. 

Gefle  Institution  for  Feeble-Minded  Girls  and  Small  Boys,  Gefle. 

Gene  Institution  for  Feeble-Minded  Boys,  Gefle. 

Gefleborgs   Lans    Working   Home    for   Feeble-Minded    Women, 
Gefle. 

Ostergotlands  Lans  Training  School  for  Feeble-Minded  Children, 
Soderkoping. 

Malmohus  Lans  Institution  for  Idiots,  Lund. 

Smalands  Home  for  Idiots,  Nannylund,  Eksjo. 

Orebro  Lans  Training  School  for  Feeble-Minded  Children,  Orebro. 

Upsala  Lans  Institution  for  Idiots,  Rickomberga,  Upsala. 

Upsala  Lans  Home  for  Idiots,  Karlsro,  Upsala. 

Stockholm  Lans  Institution  for  Idiots,  Hammarby,  Vasby. 

Blekinge    Lans    Training    School    for    Feeble-Minded    Children, 
Karlshamn. 

Christianstads  Lans  Institution  for  Idiots,  Hessleholm. 

Vermlands  Lans  Training  School   for  Feeble-Minded  Children, 
Karlstad. 

Delarnes  Home  for  Idiots,  Falun. 

Skaraborgs  Lans  Asylum  for  Idiots,  Skofde. 

Training  School  for  Feeble-Minded  Children,  Stretered,  Molndal. 

Norrkoping  Institution  for  Feeble-Minded  Children,  Norrkoping. 

Home  for  Epileptic  Children,  Mariehall,  Sundbyberg. 

School    for    Feeble-Minded    Children    (Caroline   von    Vegesacks 
minnie  Carlsvik),  Sodertelje. 

Institution  for  Feeble-Minded  Children,  Traleborg,  Jonkoping. 

Home  for  Feeble-Minded  Children,  Wilhelmsro,  Jonkoping. 

The  Refuge  Asylum  for  Idiots,  Wilhelmsdal,  Vernamo. 

The  Refuge  Asylum  for  Untrainable  Idiots  with  or  without  Epi- 
lepsy, Wilhelmsro,  Jonkoping. 

Asylum  for  Feeble-Minded  Children,  Carlslund,  Vasby. 

Asylum  for  Untrainable  Idiots,  Ahus. 

Home  for  Feeble-Minded  Children,  Goteborg. 


74  HISTORY. 

Norway. 

Linden,  Christiania,  for  idiotic  boys. 
Thorshaug,  Christiania,  for  idiotic  girls  and  epileptics. 
Uren  Puddeford,  near  Bergen,  for  idiotic  children. 
Hop,  Bergen,  for  the  feeble-minded. 
Bergen,  schools  for  backward  children. 
Christiania,  schools  for  backward  children. 
Throndbjem,  schools  for  backward  children. 
Ullersvedsvien  School  for  Feeble-minded  Boys. 

Russia. 

Riga.     Institute  for  feeble-minded  children. 

Finland. 

Jakobsstad.     Institute  for  idiots. 
Pistrila.     Institute  for  feeble-minded. 
Helsingfors.     Institute  for  feeble-minded. 

Holland. 

The  Hague.     Institute  for  idiots. 

Austria. 

Prague.     Institution  for  feeble-minded  children. 

Graz-Styria.     Institution  for  feeble-minded  children. 

Stephanie  Institution,  for  feeble-minded  children,  Biedermansdorf 
near  Vienna. 

Ybbs  Institution  for  Blind.     Department  for  feeble-minded  chil- 
dren. 

Switzerland. 

Zurich,  Hottingen. 

Bern,  Weissenheim. 

Bern,  Zur  Hoffnung. 

Waedensweil,  Buehl. 

Etoy,  Asylum  de  l'Esperance. 

Regensburg,  Educational  Institute. 

Aarau,  Biberstein. 

Aargau,  Bremgarten. 

Bremgarten,  St.  Joseph. 


HISTORY.  75 

Weinfelden,  Friedheim. 
Erlenbach,  Mariahalden. 
Solothurn,  Kriegstetten. 
Thurgau,  Mauren. 
Grauhinder,  Massano-Chic. 
Canton  Baselland,  Rienberg. 
Massaus  pri  Clure. 
Zurich,  Dielsdorf,  Regensberg. 
Zurich,  Rosengarten  bei  Regensberg. 

Belgium. 

Manage,  Hainault.     For  idiots  and  epileptics. 

Reves,  Hainault.     For  imbecile  and  backward  children. 

Limbourg,  Asylum  of  Tessenderloo.     For  imbeciles. 

Lokeren,  La  Maison,  St.  Benoit.     For  feeble-minded  children. 

Institution  of  St.  Ferdinand.  For  moral  imbeciles,  epileptics  and 
feeble-minded. 

Guislam,  Ghent.  School  for  mental  defectives  in  the  insane  hos- 
pital. 

Imbeciles  are  received  at  the  insane  colonies  of  Gheel  and  Lierneux. 

Ghent,  Royghen.  Asylum  for  deaf-mutes,  receives  imbecile  chil- 
dren. 

Brussels  and  Antwerp.     Schools  for  backward  children. 

Italy. 

Vercurago,  Province  of  Bergamo.     School  for  feeble-minded. 

Milan.     Signora  Segatelli's  school  for  backward  children. 

Classes  for  feeble-minded  in  asylums  for  deaf-mutes  in  Milan  and 
Alexandria. 

Rome.     Dr.  De  Sanctis'  school  for  backward  children. 

Schools  for  backward  children  at  Genoa,  Rome,  Sienna,  Reggio- 
Emilia  and  Bologna. 

School  of  Saint- John-Persiceto. 

The  Tuscan  School,  Settignano,  near  Florence. 

England. 

Eastern  Counties  Asylum,  Essex  Hall,  Colchester. 
Western  Counties  Asylum,  Starcross,  Exeter. 


y6  HISTORY. 

Midland  Comities  Idiot  Asylum,  Knowle,  Birmingham. 

Earlswood  Asylum,  Red  Hill,  Surrey. 

Royal  Albert  Asylum,  Lancaster.  (a)Brunton  House  Branch  for 
boys,     (b)  The  Story  Home  for  girls. 

Magdalen  Hospital,  Bath. 

Metropolitan  Asylums  Board. 

Darenth  Schools,  Dartford,  Kent. 

Middlesex  County  Asylum.     Annex  for  Imbeciles. 

Winwick  Hall  for  Boys,  Lancashire. 

Ancaster  House,  Richmond  Hill,  Surrey. 

Winchester  House,  Kingston  Hill. 

Normansfield,  Hampton  Wick,  Middlesex. 

Special  classes  for  defective  children,  numbering  some  sixty,  are 
scattered  throughout  London,  and  there  are  a  number  in  the  pro- 
vinces. 

Scotland. 

Larbert,  Sterlingshire.  Scottish  National  Institution  for  Imbecile 
Children. 

Mavisbush,  Polton,  Midlothian. 

Baldovan  Asylum  for  Imbecile  Children  near  Dundee. 

Ireland. 

Palmerston,  Dublin.  Stewart  Institution  for  Idiotic  and  Imbecile 
Children. 

British  Colonial. 

Canada.     Orillia,  Ontario. 

South  Africa.  Cape  Colony.  Grahamstown  Insane  Asylum; 
separate  department  for  idiot  children. 

Australia.  Melbourne.  Separate  department  for  imbeciles  in 
Kew  Insane  Asylum. 

Adelaide.     School  for  Feeble-Minded  Children,  Moonee  Ponds. 

Japan. 

Tokyo,  Mr.  Ishii's  (Osuga)  institution  for  feeble-minded  children. 
Defective  children  are  also  received  in  the  Deaf  and  Dumb  Insti- 
tution at  Tokyo. 

America. 
Massachusetts,  Waverly. 

"  Barre   (private). 


Plate  XII. 


IMBECILES  —  LOW-GRADE. 


HISTORY. 

New  York,  Syracuse. 

Rome   (custodial). 

Newark   ( women ) . 

Randall's  Island. 

Sonyea   (epileptic  colony). 
Pennsylvania,  Elwyn   (private,  with  state  patronage). 
Polk. 

Oakbourne  (epileptic  hospital). 
Ohio,  Columbus. 

Connecticut,  Lakeville  (private,  with  state  patronage). 
Kentucky,  Frankfort. 
Illinois,  Lincoln. 
Iowa,  Glenwood. 
Indiana,  Fort  Wayne. 
Minnesota,  Faribault. 
Kansas,  Winfield. 
California,  Eldridge. 
Nebraska,  Beatrice. 

New  Jersey,  Vineland   (private,  with  state  patronage). 
Vineland  (women). 
Skillman  (epileptic  village). 
Maryland,  Owings  Mills. 
Washington,  Vancouver. 
Michigan,  Lapeer. 
Wisconsin,  Chippewa  Falls. 
Missouri,  Marshall. 
New  Hampshire,  Laconia. 
North  Dakota,  Jamestown. 


77 


CHAPTER   III. 


CLASSIFICATION. 

To  the  student  of  mental  defect  the  very  first  requisite  is  a  classifi- 
cation that  shall  be  at  once  simple  and  comprehensive,  definite  and 
clear.  Various  leaders  in  the  work  have  each,  from  time  to  time, 
endeavored  to  formulate  such  a  classification  embodying  the  results 
of  his  study  and  experience ;  but  the  conditions,  incident  upon  diver- 
sity of  times  and  nationalities,  as  well  as  the  differences  of  bases 
constituting  premises,  has  so  far  prevented  the  adoption  of  a  standard 
of  comparison  resulting  in  one  common  order  of  classification. 

Yet  another  obstacle,  has  been  the  persistent  inclusion  of  idiocy 
with  insanity  in  many  of  the  earlier  medical  writings  leading  to 
much  misapprehension.  Thus  as  Howe  shows,  Good  establishes  the 
order  Phrenica,  diseases  of  the  brain,  and  subdivides  it  into  six  gen- 
era, the  last  of  which,  Moira,  is  subdivided  into  two  species :  First, 
Imbecillis,  imbecility,  containing  four  varieties — first,  stupiditas; 
second,  amentia,  forgetfulness ;  third,  credulitas ;  fourth,  inconstan- 
tia.  The  second  species,  Demens,  irrationality,  has  three  varieties, 
first,  stultitia,  folly,  silliness;  second,  larema,  dotage,  superannua- 
tion; third,  ancea,  idiotism.  Here  we  have  6  genera,  15  species,  and 
27  varieties  of  mental  disease. 

Ray  gives  two  divisions  of  insanity: 


Insanity. 


Defective  devel- 
opment of  the 
faculties. 

Lesion  of  the  fac- 
ulties subse- 
quent to  their 
development. 


Idiocy. 


Imbecility. 


Mania. 


1.  Resulting  from  congenital   de- 

fect. 

2.  Resulting  from   an  obstacle  to 

the  development  of  the  facul- 
ties, supervening  in  infancy. 

1.  Resulting   from  congenital  de- 

fect. 

2.  Resulting  from  an  obstacle   to 

the  development  of  the  facul- 
ties, supervening  in  infancy. 


Intellectual,   X 
Affective, 


General. 
Partial. 


(    1.   General. 
\    2.   Partial. 


Dementia. 
78 


1 .  Consecutive  to  mania,  or  injuries 

of  the  brain. 

2.  Senile,  peculiar  to  old  age. 


CLASSIFICATION.  79 

A  comparison  of  recognized  authorities  followed  up  in  such  order 
as  to  embrace  the  experience  of  successive  periods  invites  interested 
study,  and  may  in  time  prove  a  means  to  a  much  desired  end. 

The  first  scientific  classification  was  made  by  Seguin  in  1846, 
although  some  observations,  most  superficial,  had  been  noted  previ- 
ous to  this,  chiefly  among  adult  imbeciles  in  asylums  for  the  insane. 
Seguin,  assuming  that  the  mental  and  moral  features  of  idiocy  are 
dependent  upon  conditions  of  the  nervous  system,  based  his  classi- 
fication therefore,  upon  the  seat  or  location  of  these  underlying  phys- 
ical conditions,  thus :  "  The  remote  cause  or  source  may  be  physio- 
logical or  pathological;  the  immediate  cause  is  in  abnormal  condi- 
tions, either  of  the  central  nervous  masses  or  in  the  nervous  appa- 
ratus radiating  from  these  centres,  and  which  connect  them  with 
the  individual  environments."  Going  still  further,  he  enumerates, 
first,  "  profound  idiocy  "  as  "  the  chronic  affection  of  a  whole  or  a 
part  of  the  central  nervous  masses  " ;  second,  "  superficial  idiocy," 
"  a  partial  or  total  affection  of  the  nervous  apparatus  which  ramifies 
through  the  tissues  and  presides  over  the  life  of  relation  "  ;  and  third, 
"  backward  children  "  in  whom  there  is  a  retarded  mental  develop- 
ment that  appears  to  be  "  the  result  of  mere  functional  inactivity  of 
the  nervous  system." 

Esquirol  dividing  mental  defectives  into  two  classes — imbeciles 
and  idiots — makes  a  subdivision  based  upon  power  of  speech.  In 
the  first  degree  of  imbecility,  the  speech  although  easy  and  rapid  con- 
sists only  of  detached  words,  short  phrases  or  broken  sentences. 
The  second  shows  a  yet  more  limited  vocabulary  often  reduced  to 
mere  monosyllables  or  cries.     The  third  presents  absolute  mutism. 

Howe  divided  mental  defectives  into  three  classes — "  idiots,  fools, 
and  simpletons."  He  claimed  that  "  Idiocy,  like  insanity,  may  be 
intellectual  or  moral  or  both,  and  it  may  include  all  or  any  part  of 
those  classes  of  powers,  and  in  any  variety  or  combination." 

Duncan  and  Millard  give  a  classification  apparently  based  upon 
conditions  resulting  from  disease : 

"  Class  I. — True  and  profound  idiots :   solitaires. 

"  Class  II. — Having  a  slight  amount  of  intelligence,  being  able  to 
stand  and  walk  a  little,  and  often  capable  of  slight  instruction. 

"  In  these  two  classes  the  affliction  exists  at  birth,  and  there  are 


80  CLASSIFICATION. 

malformations  and  disabilities  of  various  parts  of  the  body.  They 
are  beings  suffering  from  various  functional  disturbances,  from  per- 
version of  special  and  common  sensation,  from  paralysis  of  sets  of 
muscles,  and  from  inability  to  coordinate  many  more  or  less  compli- 
cated muscular  movements  to  a  common  end. 

"  Class  III. — Able  to  walk,  run,  to  use  their  fingers,  to  be  made 
to  attend  slightly,  to  do  easy  mechanical  work,  and  to  feed  them- 
selves; memory  and  perception  very  weak,  and  variable  in  power. 
Their  walking  is  defective;  the  voice  rarely  or  never  perfect;  the 
memory,  intellectual  perception,  foresight,  etc.,  are  very  defective 
and  often  absent.  The  power  of  abstract  reasoning  is  generally 
wanting  and  seldom  to  be  traced  except  in  very  slight  degree. 
Automatic  movements  are  common. 

"  Class  IV. — Feeble-minded  children,  adolescents  and  adults. 

"  Class  V. — Born  with  perfect  intelligence  and  with  the  usual  gifts 
of  children.  A  state  of  mind  produced  by  disease  of  the  brain,  epi- 
lepsy, hydrocephalus,  or  by  injury  to  the  head.  Malformation  may 
or  may  not  exist,  and  muscular  powers  with  ability  to  walk  or  speak 
are  variable. 

"  Class  VI. — Resembling  Class  V.,  but  the  evidence  of  perma- 
nent disease  of  the  brain  exists  in  the  form  of  epileptic  seizures  and 
paralysis. 

"  Class  VII. — Cases  born  with  hydrocephalus,  or  in  which  the 
disease  has  been  arrested  after  it  has  destroyed,  more  or  less,  the 
power  of  the  brain. 

"  Class  VIII. — Cases  of  individuals  who  have  been  educated  and 
who  have  become  debased  in  mind  and  body  during  youth  from 
vice." 

Hack  Tuke  has  chosen  a  gauge  of  motor  power  as  the  basis  of  his 
classification,  thus : 

"  First,  Those  who  exhibit  nothing  beyond  the  reflex  movements 
known  as  the  excito-motor. 

"  Secondly,  Those  whose  reflex  acts  are  consensual  or  sensori- 
motor, including  those  of  an  ideo-motor  and  emotional  character. 

"  Thirdly,  Those  who  manifest  volition — whose  ideas  produce 
some  intellectual  operations  and  consequent  will." 

Griesinger  gives  a  classification  embracing  five  types : 


CLASSIFICATION.  8 1 

"  I.  Well-formed  children,  in  whom  the  mental  development, 
which  remains  at  the  lowest  grade,  is  the  only  apparent  defect,  the 
defect  not  being  due  to  any  hereditary,  but  to  some  accidental  cause 
of  degeneration. 

"  2.  The  cases  in  which  both  bodily  and  mental  development  have 
been  palpably  arrested :  these  are  the  dwarfs  in  mind  and  body. 

"  3.  The  Cretin,  or  basilar-synostotic  type  of  idiocy  or  imbecility. 

"  4.  The  Aztec  type,  consisting  of  the  microcephalic  idiots. 

"  5.  The  theroid  idiots,  who  have  a  sort  of  resemblance  to  some 
animal." 

Hoffbauer  gives  three  classes.  The  first  and  second  stand  related 
according  to  comparative  powers  of  judgment;  the  third  altogether 
clouded  with  delusions  of  evil  and  attacks  of  passionate  anger  ap- 
proaching to  insanity : 

"  The  first  class  was  unable  to  form  a  judgment  on  a  new  subject 
no  matter  how  simple.  He  could  judge  well,  however,  on  familiar 
subjects.  Memory  weak,  although  he  observes  a  certain  routine  of 
occupation  with  scrupulous  exactness.  He  is  not  liable  to  talk  much 
of  himself,  but  is  liable  to  sudden  paroxysms  of  anger. 

"  The  second  degree  is  even  less  capable  to  judge  and  act  in  re- 
gard to  his  accustomed  occupations.  He  is  exceedingly  confused  in 
regard  to  the  place  in  which  he  is  and  the  person  with  whom  he  con- 
verses, and  is  very  generally  at  fault  in  regard  to  his  ideas  of  time. 

"  In  the  third  degree  of  imbecility  there  is  more  reason  to  appre- 
hend danger  from  the  individual  affected  with  it ;  for  he  has  delusions 
of  the  evil  intentions  of  others,  and  is  not  only  passionate,  but  sus- 
picious and  misanthropic.  He  frequently  talks  to  himself.  Think- 
ing aloud',  however,  is  no  proof  of  imbecility." 

J.  Langdon  Down  considered  "  the  best  classification  of  idiocy, 
the  one  which  most  assists  in  the  prognosis  and  treatment,  is  that 
which  is  based  on  its  etiology.  The  whole  of  the  cases  may  be 
divided  into  three  important  groups,  which  groups  afterwards  admit 
of  subdivision.  The  primary  groups  are:  (i)  Congenital;  (2) 
Developmental,  and  (3)  Accidental. 

"  1.  Congenital  Idiocy. — The  congenital  group  includes  all  those 
cases  which  at  the  period  of  birth  manifest  signs  of  defective  mental 
power,  associated  usually  with  conditions  of  the  head,  skin,  and 
6 


82  CLASSIFICATION. 

other  organs,  which  are  indicative  of  a  congenital  origin.  They  are 
cases  which  have  never  possessed  ordinary  mental  power.  The  con- 
genital group  contains  the  following  subdivisions :  (a)  Strumous; 
(b)  Microcephalic;  (c)  Macro  cephalic;  (d)  Hydrocephalic;  (e) 
Eclampsic;  (/)  Epileptic;  (g)  Paralytic;  and  (h)  Choreic. 

"  2.  Developmental  Idiocy. — The  developmental  group  includes  a 
smaller  number  of  cases,  where  the  child  is  born  manifesting  an 
average  intelligence  through  infancy,  or  even  up  to  the  commence- 
ment of  puberty,  but  from  causes  which  have  influenced  the  nutrition 
of  the  embryo  during  its  intra-uterine  life,  is  born  with  a  proclivity 
to  mental  break-down  during  one  of  the  developmental  crises;  the 
crises  being  the  periods  of  the  first  dentition,  and  of  puberty.  The 
group  includes  those  cases  in  which  speech  and  mental  faculties  are 
lost  in  children  in  whom  previously  the  intelligence  was  good — cases 
where  the  brain  and  nervous  power  was  sufficient  for  its  early  years, 
but  insufficient  to  carry  it  through  evolutional  stages.  They  usually 
present  outward  signs  in  their  cranium  or  elsewhere  that  the  tendency 
to  catastrophe  was  born  with  them.  The  developmental  group  em- 
braces the  following  subdivisions:  (a)  Eclampsic;  (b)  Epileptic, 
and  (c)  Choreic. 

"  3.  Accidental  Idiocy. — The  accidental  group  includes  all  those 
cases  of  idiocy  where  the  child  has  been  born  with  a  normal  nervous 
system,  free  from  any  present  or  potential  defect,  when  unfortunately 
a  fall,  a  fright,  epilepsy,  the  result  of  some  peripheral  irritation, 
disease  of  the  bones  of  the  ear  sequential  to  measles  or  scarlet  fever, 
meningitis,  or  other  cause,  may  lead  before  puberty  to  mental  break- 
down— a  break-down  not  of  a  genetic,  but  of  a  purely  accidental 
origin.  The  accidental  group  includes:  (a)  Traumatic;  (b)  In- 
flammatory; and  (c)  Epileptic  Idiocy." 

Down  gives  later  a  physiognomical  or  ethnological  classification, 
1.  e.,  Caucasian,  Ethiopian,  Malay,  Mongolian  or  Kalmuck,  and  what 
he  is  pleased  to  call  the  American  Indian  type.  Based  upon  an  idea 
of  mere  physical  resemblance  there  seems  to  be  no  further  analogy 
of  racial  characteristics,  and  it  proves  therefore  more  interesting  to 
the  curious  than  useful  to  the  practical  observer,  more  particularly 
as  the  Mongolian  and  Negroid  types  belong  almost  exclusively  to  the 
idio-imbecile  or  imbeciles  of  low-grade. 


CLASSIFICATION.  83 

The  Malay  type  I  have  never  met  Of  the  American  Indian  type, 
in  which  according  to  Down  "  moral  and  intellectual  characteristics 
can  scarcely  be  said  to  exist,"  I  have  two  cases,  both  imbeciles — one 
high-grade,  remarkably  bright,  and  the  other  low-grade,  improvable. 
Down  ascribes  to  phthisis  the  production  of  the  Mongolian  or  Kal- 
muck type,  to  which  he  refers  10  per  cent,  of  all  cases  of  idiocy ;  but 
I  find  it  occurring  in  only  .09  per  cent,  nor  do  I  find  evidence  why 
this  special  type  should  spring  from  phthisis  rather  than  from  other 
causes,  as  only  about  one  fourth  of  my  cases  of  Mongolianism  had  a 
phthisical  history  and  with  these  there  were  various  complications. 

Again  old  age  in  parents  has  been  considered  a  cause  of  Mon- 
golianism, but  I  know  of  but  one  instance  in  which  this  could  be 
ascribed,  the  father  being  75,  and  the  mother  48  years  of  age,  the 
average  age  of  parents  being  36  for  the  fathers  and  33  for  the 
mothers.  It  is  also  said  that  last-born  children  are  apt  to  be  Mon- 
golians, but  I  find  of  this  but  one  case.  Indeed  I  do  not  find  data 
sufficiently  reliable  to  affirm  any  one  cause  above  another  in  the  pro- 
duction of  this  type. 

Ireland  bases  his  classification  on  pathologic  conditions.  He 
says :  "  I  found  it  was  necessary  to  have  some  arrangement  in  order 
to  say  clearly  what  I  wanted  to  say. 

"  Coming  to  the  study  of  idiocy  after  having  gained  some  experi- 
ence in  medicine,  I  have  from  the  beginning  viewed  it  from  the 
standpoint  of  pathology;  and  my  idea  of  idiocy  is  compounded  of 
the  following  classes,  which  are  generalized  from  individual  exist- 
ing idiots,  who  resemble  one  another  by  having  the  same  or  similar 
diseases,  as  they  resemble  the  type  of  idiocy  by  having  mental 
deficiency  along  with  a  corporeal  disease. 

"  1.  Genetous  idiocy. 

"  2.  Microcephalic  idiocy. 

"  3.  Hydrocephalic  idiocy. 

"  4.  Eclampsic  idiocy. 

"5.  Epileptic  idiocy. 

"  6.  Paralytic  idiocy. 

"  7.  Traumatic  idiocy. 

"8.  Inflammatory  idiocy  (the  result  of  encephalitis). 

"  9.  Sclerotic  idiocy. 


84  CLASSIFICATION. 

"  io.  Syphilitic  idiocy. 

"  ii.  Cretinism  (including  the  endemic  and  sporadic  or  myxoe- 
dematous  forms). 

"  12.  Idiocy  by  deprivation  (in  which  the  child  is  deprived  of  two 
or  more  of  the  principal  senses — such  as  sight  and  hearing,  with 
consequent  enfeeblement  or  actual  loss  of  mental  power." 

Shuttleworth,  like  Ireland,  classes  his  cases  pathologically.  He 
says :  "  In  connection  with  mental  deficiency  we  find  two  main 
divisions  of  cerebral  abnormality — (a)  that  arising  from  formative 
or  developmental  defect,  and  (b)  that  resulting  from  inflammatory 
or  degenerative  processes.  Each  class  of  abnormality  corresponds, 
of  course,  to  the  broad  primary  classification  of  cases  of  mental  de- 
ficiency into —  (a)  Congenital  and  (b)  Non-congenital.  There  is, 
however,  a  mixed  class  of  cases  in  which  the  actual  lesion  super- 
venes upon  a  brain  originally  imperfect  in  development,  and  to  such 
cases,  occurring  at  a  crisis  of  early  life,  has  been  given  the  name 
of  Developmental." 

He  goes  on  to  classify  congenital  mental  deficiency  thus : 

1.  Microcephalus,  and  other  formative  cerebral  defects. 

2.  Hydrocephalus  (congenital). 

3.  "  Mongol  "  or  "  Kalmuc  "  type. 

4.  Scrofulous  cases. 

5.  Birth-palsies  with  athetosis. 

6.  Cretinism  (congenital). 

7.  Primarily  neurotic. 

He  further  sums  up  the  non-congenital  type  of  mental  weakness 
thus: 

A.  Developmental  cases : 

1.  Eclampsic. 

2.  Epileptic. 

3.  Syphilitic  (inherited). 

B.  Accidental  or  acquired : 

1.  Traumatic     )  .    _  ,    . 

inflammatory  lesions. 


2.  Post-febrile 

3.  Emotional. 

4.  Toxic. 

He  further  suggests  that  the  term  subnormal  or  mentally  feeble 
be  substituted  for  imbecile  or  idiot  and  feeble-minded. 


Plate  XIII. 


CLASSIFICATION.  85 

The  school  board  of  London  has  adopted  the  following  classifica- 
tion in  the  medical  examination  of  children  for  the  special  schools: 

"  1.  Those  requiring  special  instruction. 

"  2.  Those  capable  of  continuing  in  the  ordinary  school. 

"  3.  Those  whose  mental  condition  is  too  low  for  instruction,  even 
in  special  classes.  These  last  are  excluded  with  a  recommendation 
to  their  friends  to  obtain  admission  for  them  into  an  institution  for 
imbeciles." 

Kerlin  follows  Griesinger  in  naming  two  conditions  of  idiocy — 
the  apathetic  and  the  excitable — classing  as  idiots  "  those  whose  in- 
telligence is  so  slight  as  to  be  subjects  for  habit  training  only  in  life- 
long asylum  care."  He  adds :  "  I  have  thrown  the  class  imbecile 
into  three  groups — five  or  six  might  have  been  made — the  individuals 
of  the  lowest  dropping  almost  into  idiocy,  are  susceptible  of  some  cul- 
ture of  the  hand  and  eye,  have  a  slight  command  of  language,  sign  or 
vocal,  in  communicating  their  desires  and  a  low  degree  of  attention, 
imitation,  etc.  The  middle  grade  imbeciles  are  much  superior  to  the 
low,  while  the  high  or  best  grade  are  possessed  of  all  the  attributes 
of  intelligence  in  a  limited  degree ;  they  are  taught  to  read  and  write 
in  some  instances  fluently,  to  calculate  minor  questions  of  arithmetic, 
and  approach  the  lower  range  of  common  intelligence  in  their  rela- 
tions to  life  as  found  among  the  ignorant;  in  their  most  advanced 
grade  they  are  lacking  only  in  those  powers  of  discrimination,  judg- 
ment, and  will  power,  the  attributes  of  a  sound  man ;  if  they  exercise 
them  at  all  it  is  in  mimicry  of  associates  and  superiors,  rather  than 
from  their  personal  possession.  I  also  recognize  a  condition 
analogous  to  excitable  idiocy,  among  imbecile  children  whose  mental 
powers  are  susceptible  of  normal  development,  but  whose  will  power 
and  discrimination  of  right  and  wrong  seem  to  be  strangely  per- 
verted from  infancy.  I  have  chosen  to  call  these,  instances  of  juve- 
nile insanity,  following  for  the  name  the  excellent  lead  of  some  dis- 
tinguished writers." 

These  classes  and  grades  are  thus  represented  in  tabular  form: 

"  Apathetic  idiots. 

"  Excitable  idiots. 

"  Low  grade  imbeciles. 

"  Middle-grade  imbeciles. 


86  CLASSIFICATION. 

"  High  grade  or  first  imbeciles. 

"  Juvenile  insane  imbeciles." 

This  last — the  juvenile  insane  imbecile — being  not  a  type  but  a 
combination  of  disease  and  defect  which  might  have  place  in  any 
and  every  grade  of  imbecility,  Dr.  Kerlin  must  have  recognized  as 
illogical  in  a  classification,  for  he  later  adopts  the  term  moral  im- 
becile, as  used  by  Howe  and  Seguin  to  designate  that  form  of  defect 
displayed  in  the  moral  nature  which  may  or  may  not  be  associated 
with  mental  defect,  but  amounting  often  to  a  total  absence  of  the 
moral  sense.  The  portrayal  of  this  as  a  distinct  type,  and  his  in- 
sistence upon  the  imperative  demand  for  it  of  perpetual  sequestra- 
tion, constitutes  Dr.  Kerlin's  chief  contribution  to  the  work. 

His  subdivision  of  the  imbecile  class  is  clearly  along  the  line  of 
Seguin's  indications  that  the  primary  aim  of  classification  is  to  attain 
a  gauge  of  mental  capacity  that  shall  facilitate  training.  In  his  third 
or  high-grade  imbecile,  which  answers  to  the  simpleton  of  Howe, 
he  fills  the  hiatus  between  the  second  order  of  Seguin's  and  the 
feebly-gifted  or  backward,  which  Seguin  alludes  to,  but  which  is  not 
included  in  any  of  the  classifications  we  have  been  considering. 

In  a  study  of  these  various  authorities,  by  comparing  the  aim  of 
the  one  with  the  apparent  aims  of  the  many,  and  these  again  with 
the  data  which  experience  is  daily  contributing,  we  naturally  seek 
to  find  points  of  agreement  in  classification  seemingly  opposed;  to 
reconcile  apparent  differences ;  to  weigh  carefully  scientific  and 
practical  values ;  and  gradually  by  a  process  of  elimination  and 
condensation  to  arrive  at  a  classification  which,  as  addressing  itself  to 
the  needs  of  the  greatest  number,  shall  further  the  best  interests  of 
the  work. 

That  the  pathological  classification  of  Down,  Ireland  and  Shuttle- 
worth  is  valuable,  none  will  deny,  for  it  is  to  the  pathology  of  idiocy 
that  we  look  for  light  in  etiology,  diagnosis,  and  prognosis,  but 
pathology  needs  still  to  pursue  its  invaluable  work  of  the  collection 
of  facts  regarding  idiocy,  for  as  yet  its  researches  in  this  field  have 
not  gathered  sufficient  data  on  which  to  base  authoritative  opinion. 

As  far  back  as  1877,  H.  C.  Wilbur  discussing  classification  before 
the  Association  of  Medical  Officers  of  American  Institutions,  while 
endorsing  the  pathological  from  a  medical  standpoint,  adds :    "  It 


CLASSIFICATION.  87 

should  be  borne  in  mind  that  the  essential  fact  of  idiocy  is  the  men- 
tal deficiency ;  that  the  actual  work  of  obviating  the  condition  is  an 
educational  one,  using  the  term  in  a  broad  sense;  and  if  any  favor- 
able effect  is  produced  upon  abnormal  organic  states,  it  will  ordi- 
narily be  through  the  reflex  action  of  properly  adjusted  mental  ex- 
ercises. Incidentally,  we  notice  the  associated  pathological  condi- 
tions or  complications,  less  from  their  supposed  relation  as  causes 
of  the  idiocy,  but  as  interfering,  to  a  greater  or  less  degree,  with 
our  efforts  at  instruction  or  training.  The  manifestations  upon 
which  we  base  our  prognosis  are  more  subtile  than  the  accompany- 
ing conditions  of  microcephalus  or  paralysis,  or  others  that  form 
the  basis  of  any  pathological  classification. 

"  Do  we  not  need  some  effective  form  of  description  of  our  cases ; 
some  generally  recognized  tests  of  physical  and  mental  condition  that 
will  show,  in  the  first  place,  the  starting-point  in  the  pupil's  career, 
to  which  reference  can  be  made  from  time  to  time  to  test  their  abso- 
lute or  relative  progress?  Do  we  not  need  some  mile-posts  along  in 
the  educational  path  to  the  same  end? 

"  I  commend,  then,  to  your  attention  the  hitherto  undefined  and 
unrecorded  signs  and  features  of  mental  and  moral  condition,  the 
peculiar  habits  of  the  different  shades  and  grades  of  idiocy,  that  at 
our  next  or  some  future  meeting  we  may  be  able  to  agree  upon  some 
form  of  classification  that  shall  meet  the  need  I  have  spoken  of." 

Not  only  do  we  find  it  necessary  to  have  sound  argument  in 
order  to  say  clearly  what  we  want  to  say,  as  Ireland  expresses  it, 
but  we  must  consider  the  large  number  to  be  enlightened  through 
this  argument ;  and  furthermore  that  the  general  public,  the  parents 
and  the  teachers  and  attendants  engaged  in  the  work  need  a  classifi- 
cation that  shall  be  an  exponent  guiding  them  away  from  the  fallacy 
and  delusion  of  cure,  into  the  actual  possibility  that  the  child,  always 
defective,  may  yet  accomplish.  Experience  has  made  clear  and  has 
gradually  evolved  a  consensus  that  our  one  great  aim  is  not  cure, 
but  a  three-fold  protection.  Protection  of  the  helpless  from  want; 
of  the  irresponsible  from  ignorance,  vice  and  the  penalty  of  crime ; 
and  lastly,  the  protection  of  the  family  and  the  state  from  the  evils 
of  association  and  of  certain  increase.  To  accomplish  this,  we  must 
address  the  public  in  terms  that  he  who  runs  may  read  and  in  terms, 


88  CLASSIFICATION. 

moreover,  that  do  not  offend  the  sensitive.  It  is  upon  such  prin- 
ciples, whether  avowed  or  unavowed,  that  in  America  the  expression 
feeble-minded  has  come  to  be  the  term  covering  every  phase  of  men- 
tal defect,  and  our  training-schools  have  increased  as  they  never 
could  have  done  under  the  misnomer  of  schools  for  idiots.  Not 
only  is  its  meaning  plain  and  therefore  acceptable  to  the  popular 
mind,  but  it  forms  a  logical  basis  for  the  reasoning  of  both  physi- 
cians and  teachers.  It  is  broad  and  covers  much,  is  easily  under- 
stood, and  best  of  all  it  is  true.  All  are  feeble  in  varying  degrees, 
needing  various  modes  of  treatment  or  of  training;  and  as  aids  to 
treatment  and  training  many  of  the  terms  used  in  the  different  classi- 
fications are  undoubtedly  invaluable. 

The  first  step  in  a  scheme  of  general  protection  is  naturally  to  con- 
sider the  helpless  and  the  untrainable ;  and  what  more  natural  than 
to  class  him  according  to  the  literal  meaning  of  the  word  in  the  orig- 
inal Greek,  as  idiot — one  solitary,  alone,  and  therefore  needing  for 
life,  care  in  asylum.  There,  whether  excitable  or  apathetic,  we  place 
him  and  can  study  him  and  treat  him  under  all  the  forms  enumerated. 
But  whether  he  be  microcephalic  or  hydrocephalic,  paralytic  or  epi- 
leptic, Mongolian  or  Ethiopian,  he  presents  the  lowest  form  of  men- 
defect — idiocy — and  we  can  make  the  public  understand  that  as  such, 
he  is  absolutely  untrainable,  often  unimprovable. 

In  the  next  class  we  find  those  who  are  to  be  protected  from  igno- 
rance and  vice.  Protection  from  ignorance  presupposes  a  capacity 
for  sense  training,  and  for  adaptation  to  environment,  varying  in 
degree  from  ability  for  the  very  simplest  offices  of  self-help  or  aid 
to  another,  to  that  of  a  certain  dexterity  in  the  industrial  and  manual 
arts  under  direction.  He  may  be  fool  or  simpleton,  he  may  or  may 
not  be  lacking  in  power  of  speech  or  of  locomotion,  yet  always  he 
is  feeble,  vacillating,  needing  a  support,  a  staff — therefore  imbecile. 
Thus  experience  and  reasoning  have  brought  us  from  the  generic 
title  feeble-minded,  to  its  two  large  sub-divisions,  idiot  and  imbecile, 
which  indicate  according  to  the  strict  meaning  of  the  words  in  the 
original  tongues,  one  the  solitary,  the  other  the  totterer ;  and  which 
separate  therefore  our  helpless  and  untrainable  from  our  unstable  but 
nevertheless  trainable  and  possibly  helpful  class.  These  two  states 
are  naturally  traceable  to  nervous  conditions,  also  distinct  and  dif- 


Plate  XIV. 


H  0 


wSkJfrto 

1£M>        I/, 

K;          JE 

Mp*>-    w> 

%9k  '  :':-  1L 

^3 

*Wm^ 

IMBECILES  —  MIDDLE-GRADE. 


EDUCATIONAL    CLASSIFICATION.  89 

ferent,  due  to  causes  congenital  or  accidental,  and  here  is  entire 
accord  with  the  foundation  of  Seguin's  argument. 

The  protection  which  society  demands  and  needs  to  be  advised  of 
is,  first  from  the  burden  of  the  untrainable  idiot  both  in  the  homes 
and  training  schools,  and  also  in  the  institutions  designed  for  other 
kinds  of  defectives,  i.  e.,  those  for  the  blind  and  deaf-mute;  second 
from  the  disadvantage  resulting  from  the  intermingling  in  the  schools 
of  normal  with  backward  children;  third  from  the  mischief  which 
whether  trained  or  untrained  the  irresponsible  imbecile  is  liable  to 
perpetrate  if  unguarded;  still  more  from  the  tragedies  certain  to  be 
enacted  by  the  moral  imbecile,  and  above  all  else,  protection  from 
increase  of  an  evil  growth  which  if  unchecked  is  inevitable. 

These  considerations,  the  outgrowth  of  practical  experience  and 
of  necessity  for  response  to  frequent  appeals  for  just  such  informa- 
tion, has  led  the  author  to  formulate  an  educational  classification, 
giving  the  extremes,  and  intermediate  grades  of  mental  defect ;  and 
not  only  defining  the  status  of  the  individual,  but  indicating  methods 
of  training  together  with  future  possibilities. 


9o 


EDUCATIONAL    CLASSIFICATION, 


EDUCATIONAL  CLASSIFICATION 


OF 


THE    FEEBLE-MINDED. 


Asylum  Care. 


Profound. 


Superficial. 


f  Apathetic.    "1    TT   .  , , 

i  "Excitable.     }    Unimprovable. 

<    p"  >  hi   '     i    ImProvable  in  self-help  only. 


IDIO-IMBECILE. 


Improvable  in  self-help  and  helpfulness. 
Trainable  in  very  limited  degree  to  assist  others. 


Custodial  Life 
and  Perpetual 
Guardian- 
ship. 


MORAL    IMBECILE. 

Mentally  and  morally  deficient. 

Low  Grade :  Trainable    in    industrial     occupations ;     temperament 

bestial. 
Middle  Grade  :  Trainable  in  industrial  and  manual  occupations  ;  a 

plotter  of  mischief. 
High  Grade :  Trainable  in  manual  and  intellectual  arts  ;  with  a  genius 

for  evil. 


Long  Appren- 
ticeship and 
Colony  Life 
Under  Protec- 
tion. 


Mentally  deficient. 

Low  Grade  :  Trainable  in  industrial  and  simplest  manual  occupations. 

Middle   Grade  :  Trainable    in    manual    arts   and    simplest    mental 

acquirements. 
High  Grade :  Trainable  in  manual  and  intellectual  arts. 


Trained  for  a 
Place  in  the 
World. 


BACKWARD   OR   MENTALLY   FEEBLE. 


Mental  processes  normal,  but  slow  and  requiring  special  training  and 
environment  to  prevent  deterioration  ;  defect  imminent  under 
slightest  provocation,  such  as  excitement,  over-stimulation  or 
illness. 


CHAPTER   IV. 


ETIOLOGY. 


The  study  of  the  etiology  of  idiocy  and  imbecility  assumes  a  new 
aspect  in  view  of  the  rapid  and  startling  growth  of  many  phases  of 
mental  defect.  That  it  might  meet  urgent  demand  with  such 
suggestions  which,  if  accepted,  should  at  least  stem  the  tide  of  a  fate- 
ful heredity,  would  be  indeed  a  consummation  fitly  crowning  the 
labors  of  those  contributing  to  its  records ;  and  a  verification  of  the 
prophecy  of  Descartes  "  that  if  it  be  possible  to  perfect  mankind,  the 
means  of  doing  it  will  be  found  in  the  medical  sciences." 

The  impossibility  of  dogmatic  assertion  as  to  any  one  cause 
being  the  supreme  agent  of  degeneration  is  obvious,  in  view  of  the 
countless  influences  of  heredity,  environment  and  accident  enveloping 
the  human  organism  from  the  moment  of  conception  to  that  of 
dissolution.  By  a  separation  of  life  into  periods,  however,  and  col- 
lecting data  sufficient  for  the  basis  of  an  opinion,  one  may  arrive  at 
a  knowledge  of  that  period  apparently  most  sensitive  to  disturbing 
influences.  Next,  a  consideration  of  the  circumstances  peculiar  to 
each  period,  should  lead  to  an  enumeration  of  causes  and  averages 
that  would,  in  time,  finally  establish  a  graduated  order  of  causes 
giving  a  trustworthy  basis  for  yet  closer  work.  For  example,  hav- 
ing found  a  priority  in  period,  and  then  the  predominating  influence 
in  that  period,  one  should  in  encountering  a  variety  of  influences  give 
credit  without  hesitation  to  that  one  whose  priority  or  prepotency 
had  already  been  established. 

Take  an  instance  of  a  bright  child  reduced  to  idiocy  after  a  fall 
or  sudden  fright.  The  family  history  may  show  an  intemperate 
father  and  an  inheritance  direct  and  collateral  for  generations  back, 
of  imbecility.  Researches  having  shown  the  period  preceding  birth 
to  be  that  most  susceptible  to  influence,  and  an  heredity  of  mental 
defect  the  most  powerful  factor ;  the  actual  cause  would  be  neither 
the  accident,  nor  the  intemperance  of  the  father,  which  would  only 

9i 


92  ETIOLOGY. 

be  agents  assisting  in  developing  the  evil,  latent  and  really  engend- 
ered by  an  inheritance  of  imbecility. 

Pursuing  this  convenient  method  of  research  two  studies  have  been 
made  on  somewhat  similar  lines,  coinciding  as  to  periods  but  differ- 
ing as  to  combinations  of  causes.  One  of  2,380  cases,  a  collaboration 
of  Drs.  Beach  and  Shuttleworth,  from  the  books  of  the  Darenth  and 
the  Royal  Albert  Asylums,  England — the  other  of  3,050  cases  com- 
piled by  the  author  from  various  sources,  but  chiefly  from  the  records 
of  the  Pennsylvania  Training  School. 

An  aggregate  of  these  5,430  cases,  showing  similarity  in  the  pre- 
ponderating influences  of  distinct  periods,  gives  a  collection  of  data 
that  should  go  far  to  establish  a  consensus  that  the  strongest  predis- 
posing causes  are  those  acting  to  transmit  mental  defect  direct,  or 
to  so  combine  and  commingle  neurotic  tendencies  as  to  produce  it. 
Not  only  are  we  called  to  consider  the  physical,  intellectual  and 
moral  relations  of  inheritance,  immediate  and  collateral,  but  the 
intra-uterine  life  as  well.  Who  then  dare  assert  that  all  are  born 
free  and  equal  "  when  inheritance  enslaves  with  ghostly  hands  that 
reach  from  graves  "  ?  A  comparison  of  these  tables  shows  an  agree- 
ment as  to  the  order  of  periods,  the  predominating  influences  in  both 
being  found  before  birth,  next  in  the  period  after  birth,  whereas  the 
least  are  those  operating  at  birth.  The  Elwyn  table  shows  64.85  per 
cent,  of  the  whole  in  the  first,  32.23  per  cent,  in  the  second,  and  only 
2.92  per  cent,  in  the  last  named. 

In  a  consideration  of  priority  of  causes  acting  before  birth,  accord- 
ing to  percentages  given,  we  find  in  the  Darenth  and  the  Royal 
Albert  table  the  largest  percentage  in  the  abnormal  condition  of 
mothers  during  gestation,  a  record  of  711  cases  giving  29.87  per 
cent.  The  Elwyn  table  places  this  cause  second,  259  cases  giving 
8.49  per  cent.,  but  finds  its  first  cause  and  largest  percentage  in  an 
heredity  of  imbecility,  835  cases,  giving  27.38  per  cent.,  which  ranks 
third  in  the  English  table,  117  cases — 4.69  per  cent. 

This  divergence  may  be  more  apparent  than  actual,  if  viewed  as 
all  such  observations  must  naturally  be  in  the  light  of  associated  con- 
ditions, and  in  proportion  as  this  includes  a  comparison  of  both 
social  and  national  life  it  becomes  the  more  interesting.  The  high 
percentage  of  the  Darenth  cases  is  ascribed  by  Dr.  Beach  to  the 


Plate  XV. 


Case  G.  Case  H. 

IMBECILES—  MIDDLE-GRADE. 


ETIOLOGY. 


93 


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ETIOLOGY. 


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ETIOLOGY.  95 

low  physical  and  mental  condition  of  the  parents.  This  would  imply 
that  they  were  on  the  border-line  of  imbecility,  a  condition  easily 
intensified,  in  the  pauper  class  to  which  they  largely  belonged,  by  the 
struggle  for  existence.  Poverty,  hard  work,  not  infrequent  intem- 
perance, and  many  anxieties  added  to  the  physical  sufferings  of  the 
period,  might  so  press  upon  the  mother  as  for  the  time  to  reduce 
her  to  a  state  of  quasi-imbecility.  If,  added  to  this,  she  should 
have  brought  to  her  office  of  motherhood  that  exhausted  vitality  from 
a  child-life  in  the  factories,  of  which  so  much  was  heard  in  England, 
such  a  condition  would  provide  fruitful  soil  for  such  a  development 
of  neuroses  latent  in  the  mother,  as  to  constitute  in  her  offspring 
almost  a  direct  inheritance  of  defect. 

Similarly,  exhausted  vitality  has  doubtless  contributed  to  both  the 
first  and  the  second  causes  exhibited  in  the  Elwyn  table,  i.  e.,  inherit- 
ance of  imbecility  and  condition  of  mothers  during  gestation.  This 
is  not  so  much  from  the  struggle  for  existence,  as  from  excitement  of 
competition  so  marked  in  America  as  interpenetrating  the  life  of 
the  masses  from  which  these  cases  were  drawn,  subsequent  to  a 
period  when  a  high-pressure  system  of  purely  intellectual  attainment 
strongly  characterized  the  schools  of  the  country.  As  a  writer  so 
aptly  puts  it :  "  The  American  mother  wants  her  child  to  be,  do,  and 
have  everything."  Thus  many  young  parents  from  their  own  cradles 
to  that  of  their  first-born,  passed  from  one  stage  of  unrest  to  another ; 
a  condition  liable  to  quicken  rather  than  to  retard  neurotic  ten- 
dencies in  themselves,  with  the  almost  certain  result  of  developing 
in  their  offspring  any  defect,  latent  though  it  may  have  been  for 
generations. 

Down  thinks  the  mental  and  physical  health  of  mothers  during 
pregnancy  of  much  importance.  In  20  per  cent,  of  2,000  cases  there 
was  marked  physical  disturbance ;  in  4  per  cent,  of  these  a  history 
of  serious  falls ;  in  32  per  cent,  a  well-ascertained  history  of  great 
mental  disturbance — distressing  tidings  of  failures,  trouble  or  death. 

Howe  also  felt  that  the  condition  of  mothers  during  gestation  had 
an  important  bearing,  but  in  the  cases  examined  by  his  commission 
there  was  either  habitual  drunkenness,  epilepsy  or  other  neuroses. 

Griesinger  believes  that  violent  shock  and  grief  cause  idiocy  but 
gives  no  statistics.  Grabham  found  this  cause  in  85 — nearly  16  per 
cent. — of  543  cases. 


96  ETIOLOGY. 

Rogers  gives  58  or  11.6  per  cent,  of  500  cases,  and  Kerlin  7  per 
cent,  of  100  cases  due  to  abnormal  condition  of  mother. 

Striking  examples  of  the  influence  of  the  condition  of  mothers 
upon  offspring  is  found  in  the  accounts  given  by  the  famous  French 
military  surgeon,  Baron  Percy,  and  by  Dr.  W.  B.  Carpenter,  of  the 
siege  of  Landau,  in  1793 ;  of  the  92  children  born  within  a  few 
months,  of  mothers  exposed  to  the  terrors  of  the  cannonading  and 
the  blowing  up  of  the  arsenal — 16  died  at  birth,  8  were  idiotic  and 
died  before  they  attained  the  age  of  five  years,  33  more  or  less  defec- 
tive died  within  ten  months  and  2  were  born  with  fractured  limbs. 

Down  states  that  similar  results  followed  the  Siege  of  Lucknow. 

Mr.  Ishii  (Osuga),  of  Tokyo,  recounts  the  effect  of  an  earth- 
quake, a  few  years  since,  upon  the  Japanese  women  then  enceinte, 
resulting  in  the  birth  of  a  large  number  of  idiotic  and  imbecile  chil- 
dren. 

Paget  cites  a  case  of  a  girl  with  a  thick  harsh  crop  of  brown  hair 
on  back  and  arms  who  bore  a  striking  resemblance  to  a  monkey.  The 
mother  had  received  a  sudden  shock  caused  by  the  monkey  of  an 
organ-grinder  springing  upon  her  back. 

I  have  two  cases  somewhat  similar  among  my  patients.  A  boy 
born  a  veritable  Esau,  with  a  thick  growth  of  reddish  hair  on  back 
and  chest;  the  mother  during  pregnancy  was  chased  by  a  cow. 

A  woman  three  months  pregnant  attending  a  circus  was  much 
frightened  by  a  "  freak  "  exhibited  under  the  name  of  "  What  is  it  ?" 
Her  child — an  idiot  girl — born  at  full  term,  presented  a  most  ex- 
traordinarily Calibanish  appearance. 

One  might  go  on  with  such  examples  ad  infinitum,  but  those  cited 
are  sufficient  to  show  that  the  immediate  effect  of  shock  or  physical 
strain,  is  such  an  abnormal  condition  in  the  mother  as  to  result  in 
direct  transmission  of  idiocy  or  imbecility  from  her  to  the  child. 

Hervey  B.  Wilbur  says :  "  The  underlying  cause  may  be  primary, 
as  an  arrest  of  development  of  nervous  structure,  imperfection  in 
quantity  or  quality,  or  again  from  failure  in  functional  activity  of 
the  same.  We  know,  also,  that  even  where  the  central  nervous 
masses  are  in  tolerably  healthy  condition,  imperfection  or  failure  in 
activity  of  the  nerves  of  relation  prevents  or  impedes  cerebral  de- 
velopment and  the  exercise  of  the  higher  mental  faculties." 


ETIOLOGY.  97 

The  idea,  of  course,  is  subjective,  and  he  is  referring  to  the  in- 
fluence of  the  progenitor  upon  the  inheritor ;  yet  could  he  have  chosen 
clearer  words  to  describe  the  actual  condition,  familiar  to  every 
physician,  of  many  mothers  during  this  trying  period,  more  espe- 
cially if,  being  primipara,  it  be  a  development  of  an  absolutely  new 
experience.  Researches  into  the  effect  of  environment,  of  emotional 
life,  and  of  what  is  termed  "  use  heredity  "  go  far  to  prove  that 
these  influences  prolonged  and  acting  and  reacting  upon  unstable 
nerve  centers  throughout  the  period  of  parturition,  tend  to  create  a 
condition  in  the  mother  so  abnormal  as  to  constitute  direct  transmis- 
sion by  her  to  offspring  of  weakness — mental,  moral  or  physical — 
singly  or  associated,  just  in  proportion  to  the  character  and  to  the  pres- 
sure of  the  influence,  and  also  to  the  character  of  any  neurosis  latent, 
but  waiting  "  on  call  "  to  arouse  to  what  may  be  only  temporary,  and 
for  that  reason  unrecognized,  activity  in  the  mother,  and  to  become 
evident  in  the  enfeebled  constitution  of  the  child.  Why  should  not 
this  be  quite  as  logical  as  is  the  accepted  theory  of  the  results  of  the 
procreative  act  during  a  debauch?  For  it  is  not  necessarily  the  in- 
temperate habit  that  is  transmitted,  but  the  enfeebled  quality — the 
utter  degenerate  make  up  of  a  drunken  man  or  woman  that  is  repro- 
duced in  their  imbecile  child.  Almost  direct  confirmation  of  this 
appears  in  the  fact  that  a  mentally  abnormal  condition  is  distinctly 
specified  in  the  majority  of  the  Beach  and  Shuttleworth  cases. 
Viewed  in  this  light  it  becomes  evident  that  the  first  causes  in  the 
two  tables  more  than  approximate,  for  they  are  largely  identical. 

If,  as  Ribot  says :  "  Among  the  various  functions  which  in  their 
united  action  constitute  life  two  are  primary,  nutrition,  which  pre- 
serves the  individual,  and  generation,  which  perpetuates  the  species," 
then  that  influence  which  tends  most  to  hamper  the  one,  and  to  injure 
or  exaggerate  the  other,  is  the  surest  enemy  to  healthful  life,  the  foe 
most  to  be  dreaded ;  and  this  I  contend  is  an  inheritance  of  mental 
defect  of  which  the  condition  of  the  mother  during  gestation  is  as  we 
have  seen  largely  one  and  the  same.  An  heredity  of  disease  may 
be  purely  physiological,  breaking  down  the  physical  powers,  but  not 
necessarily  the  mental ;  but  heredity  of  imbecility  is  both  physiologic 
and  psychologic,  the  whole  being,  physical,  mental,  and  moral,  enters 
starved  upon  a  maimed  existence — idiotic  or  imbecile.  This  is  no 
7 


98  ETIOLOGY. 

fanciful  theory,  the  835  cases  at  the  head  of  my  table  attesting  to  a 
stern  reality.  The  completeness  and  the  general  diffuseness  of  the 
degenerative  condition  induced  by  an  heredity  of  imbecility — which  I 
have  found  in  all  my  studies,  from  profound  idiocy  up  through  the 
higher  grades — has  so  convinced  me  of  its  activity  as  an  agent  in  that 
malnutrition  to  which  all  influences  tend;  that  upon  finding  it  in  a 
family  history  I  feel  no  hesitancy  in  assigning  it  as  the  primary 
cause  to  which  all  others  are  subsidiary ;  not  only  readily  assimilating 
with  them,  but  by  disintegration  and  enfeeblement  actually  predis- 
posing the  system  to  their  attack.  The  fatality  of  such  heredity  is 
evidenced  in  its  repetition,  not  infrequently  several  members  of  one 
family  showing  its  influence,  and  unfortunately  such  families  are  not 
apt  to  number  few  individuals ;  for  the  animal  instincts  increase  in 
proportion  to  the  enfeeblement  of  the  mental  powers,  so  that  brothers 
and  sisters  mentally  defective  are  by  no  means  the  exception.  Indeed 
a  large  proportion  of  the  families  from  which  I  have  severally  drawn 
my  cases  show  this  reduplication:  such  as,  3  families  with  3  each; 
2  families  with  5  each ;  1  with  4 ;  and  1  family  with  2  imbecile  chil- 
dren had  a  connection  of  83  mental  defectives,  the  result  of  a  cen- 
tury of  imbecile  heredity. 

A  man  of  38  years,  feeble-minded,  has  a  delicate  wife  who  in 
twenty  years  has  born  him  19  defective  children. 

Another  family  numbers  12,  all  mentally  deficient  in  varying 
grades,  the  father  being  a  high-grade  imbecile. 

Yet  another  shows  three  generations  of  defect.  The  maternal 
grandmother  feeble-minded;  the  mother  a  feeble-minded  epileptic; 
the  father  a  shiftless  irresponsible  unable  to  provide  for  his  family 
of  seven  idiotic  and  imbecile  children. 

The  L.  family  numbers  7  individuals ;  parents  and  children  all 
imbecile.  The  family  history  shows  some  32  relatives  of  the  father 
to  be  feeble-minded,  and  the  mother  has  a  feeble-minded  sister.  The 
5  children — 2  boys  and  3  girls — imbeciles  of  high  and  middle-grade, 
have  been  trained  in  manual  and  industrial  work.  The  girls,  who 
both  sing  and  dance,  are  quite  proficient  in  household  service,  plain 
sewing,  embroidery  and  tapestry-weaving,  and  one  boy  is  an  excel- 
lent baker.  All  work  well  under  direction  and  protection,  but  the 
eldest  girl,  going  out  in  the  world  to  earn  a  livelihood  in  domestic 
service,  soon  went  astray. 


ETIOLOGY.  99 

Grabham's  testimony  reads :  "  Nearly  65  per  cent,  of  my  800  cases 
are  stated  to  be  congenitally  defective;  and,  when  we  consider  how 
difficult  it  is,  even  for  a  skilled  observer,  to  detect  idiocy  in  early 
infancy,  we  may  feel  sure  that  this  percentage  has  not  been  over- 
stated. In  about  18  per  cent.,  hereditary  taint  is  admitted;  but  I 
am  convinced  that  it  exists  in  a  far  greater  proportion."  Kerlin 
reaches  a  similar  conclusion,  his  study  of  100  cases  giving  also  18 
per  cent. 

Rogers  in  his  study  of  500  cases  found  8,  or  1.6  per  cent,  direct 
heredity,  and  15,  or  3  per  cent,  indirect.  In  156  cases  where  no 
cause  was  assigned  he  found  29,  or  18.6  per  cent.,  had  relatives  who 
were  feeble-minded. 

Down  thinks  there  can  be  no  doubt  that  one  of  the  great  causes 
of  idiocy  is  heredity  and  adds :  "  In  only  16  per  cent,  did  I  fail  in 
obtaining  a  grave  history  of  physical  or  psychical  decadence." 

Ireland  states  that  it  has  been  repeatedly  observed  that  families  in 
which  neuropathic  members  appear,  are  often  more  prolific  than 
the  average.  He  gives  no  statistics  of  imbecile  heredity,  but  states 
that  the  children  of  feeble-minded  women  are  likely  to  inherit  the 
mental  weakness  of  the  mother,  and  shows  how  this  is  confirmed  by 
the  report  of  the  Scottish  Lunacy  Commission  which  records  126 
imbecile  women  with  children  all  more  or  less  defective. 

The  Massachusetts  Commission,  1848,  in  its  report  of  574  idiots, 
shows  over  22  per  cent,  due  to  heredity  of  mental  defect,  direct  or 
collateral,  thus :  49  idiotic  persons  who  have  1  near  relative  idiotic ; 
9  who  have  2 ;  6  with  3 ;  4  with  4 ;  6  with  5 ;  3  with  10 ;  1  with  19 ; 
50  whose  parents  are  either  idiotic  or  insane,  and  21  who  are  them- 
selves parents.  This  is  interesting  when  compared  with  the  Eighth 
Annual  Report  of  the  Massachusetts  State  Board  of  Public  Charities 
in  1872,  which  states  that  "  idiots  increase  in  numbers,  and  the  rate 
of  increase  is  greater  than  that  of  the  general  population." 

The  Connecticut  Commission  in  its  investigations  as  far  back  as 
1856  found  51  idiots  in  17  families,  being  an  average  of  3  to  a 
family,  and  2  families  had  each  5  idiots.  It  further  reports  two 
or  three  towns  in  which  there  are  families  wholly  imbecile — both 
parents  and  children.  "  In  one  instance,  where  a  pauper  female  idiot 
lived  in  one  town,  the  town  authorities  hired  an  idiot  belonging  to 


1 00  ETIOLOGY. 

another  town,  and  not  then  a  pauper,  to  marry  her,  and  the  result  has 
been  that  the  town  to  which  the  male  idiot  belongs,  has  for  many 
years  had  to  support  the  pair  and  the  3  idiot  children." 

Adequate  cause  is  reported  for  310  of  531  cases  examined:  of 
these,  defective  mental  capacity  in  one  or  both  parents  is  noted  in 
65  of  185  cases;  consanguinity  in  20  cases;  tendencies  to  consump- 
tion, scrofula  or  eruptive  disease  41  of  145  ;  fright  or  grief  to  mother 
during  the  period  of  gestation  in  53  out  of  108  cases;  epilepsy  in  76; 
masturbation  in  19;  feeble  condition  of  parents  33  of  163  cases; 
insanity,  blindness  and  mixed  neuroses  in  70  of  164  cases;  and 
vicious  habits  of  parents — what  we  would  doubtless  class  as  moral 
imbecility,  in  which,  however,  intemperance  (76  cases)  is  included 
— in  95  out  of  235  cases.  As  will  readily  be  seen  a  large  proportion 
of  these  causes  may  be  resolved  according  to  our  previous  argument 
into  an  heredity  of  imbecility. 

The  Illinois  State  Board  of  Public  Charities  in  1870  deplores 
"  the  association  of  the  sexes,"  which  in  most  almshouses  could  not 
then  be  prevented,  leading  "  to  unmentionable  evils  of  which  one  is 
the  perpetuation  of  the  degeneration  of  the  race."  This  would  seem 
to  point  to  imbecile  heredity  as  an  active  agent  in  the  statistics  given 
of  65  families  in  which  there  were  2  idiots  each ;  25  with  3 ;  2  with 
4;  1  with  5,  and  1  with  6;  94  families  in  all,  with  an  aggregate  of 
224  idiot  children. 

There  is  yet  another  strain  in  this  most  pernicious  of  all  heredities, 
of  which  numerous  examples  may  be  cited  without  referring  to  the 
many  which  criminology  gives ;  crimes  of  which  defectives  are  often 
the  innocent  authors,  and  which  are  repeatedly  traceable  to  the  in- 
fluence of  an  heredity  not  immoral  but  ammoral.  Studies  in  anthro- 
pology have  proven  that  the  presence  or  absence  of  certain  physical 
peculiarities  or  characteristics  in  the  progenitor  is  certain  to  be  mani- 
fested in  progeny  in  one  or  another  generation,  and  psychology  attests 
with  equal  insistence  to  the  power  of  heredity  over  the  psychic 
attributes.  Now  in  ammoral  imbecility  there  is  partial  or  absolute 
absence  of  the  moral  sense  often  as  complete  as  is  the  absence  of 
sight  in  the  blind.  This  may  not  necessarily  be  associated  with  phys- 
ical or  mental  defect,  but  it  constitutes  a  defect  of  its  own — a  phase 
in  which  moreover  there  is  regular  and  persistent  degeneration,  and 


Plate  XVI 


ETIOLOGY.  IOI 

its  influence  in  heredity  is  far-reaching,  liable  to  reappear  in  its  own 
or  in  another  form  of  defect.  The  following  are  examples,  not  ex- 
ceptions, of  an  unvarying  rule. 

J.  S.,  a  man  of  high  social  position,  was  closely  related  to  one  of 
the  famous  presidential  families ;  his  wife  one  of  three  sisters  all 
noted  beauties.  With  every  advantage  of  education  and  culture, 
a  gifted  artist  excelling  in  miniature  painting,  in  which  he  gained 
a  reputation  for  exquisite  delicacy  of  coloring  and  attention  to  de- 
tail ;  he  was  nevertheless  a  moral  imbecile,  brutal  in  his  treatment 
of  his  children  and  of  the  wife  with  whom  he  lived  for  over  forty 
years  in  a  silence  unbroken  by  the  interchange  of  a  single  word.  Of 
five  children — three  sons  and  two  daughters — two  sons  inheriting  all 
their  father's  brilliancy  and  artistic  tastes  were  moral  imbeciles ;  one 
a  thief,  a  liar,  a  profligate  and  a  fugitive  from  justice;  the  other  a 
minister  of  religion  admired  for  his  talents,  but  untruthful,  dis- 
honest and  unreliable,  losing  the  esteem  of  all  good  people  as  rapidly 
as  he  gained  it ;  had  a  son,  also  a  pronounced  moral  imbecile. 

Of  the  three  normal  children,  a  daughter  inheriting  her  mother's 
beauty,  had  three  sons  all  mentally  defective.  Another  example  of 
atavism  or  latent  neurosis,  I  have  encountered  in  a  case  somewhat 
similar  where  the  grandfather  was  a  moral  imbecile,  and  the  neurosis 
latent  in  the  second,  appeared  intensified  in  two  imbecile  children  of 
the  third  generation. 

The  following  is  not  only  an  example  of  reversional  heredity,  but 
shows  the  close  relations  existing  between  two  extremes  of  abnor- 
mality— genius  and  imbecility.  A  boy,  a  pronounced  type  of  moral 
imbecility,  is  the  great-grandson  of  a  mental  defective;  the  grand- 
father was  a  man  of  brilliant  talent,  an  actor  of  international  repu- 
tation; the  father  a  man  of  ordinary  ability. 

An  exhaustive  research  into  the  influences  of  heredity  has  been 
made  by  Oscar  G.  McCulloch,  of  Indianapolis,  Indiana,  in  his  study 
of  the  "  Tribe  of  Ishmael."  Records,  the  author  claims,  are  scant 
up  to  the  fourth  generation,  although  there  is  reasonable  evidence  of 
"  transmission  "  from  the  old  convict  stock  which  England  threw 
into  this  country  in  the  seventeenth  century.  However,  from  that 
generation  and  the  marriage  of  a  diseased  man — John  Ishmael — with 
a  half-breed  woman,  the  narration  of  facts  begins.     There  is  one 


102  ETIOLOGY. 

continuous  history,  covering  a  period  of  48  years,  touching  almost 
every  known  crime,  filling  over  7,000  pages,  tracing  through  30 
families  out  of  a  possible  250,  no  less  than  5,000  degenerates  of  all 
sorts  and  kinds  interwoven  and  reduplicated  by  illicit,  consanguinous 
and  incestuous  connection. 

The  remarkable  history  of  "  The  Jukes  "  compiled  by  Richard 
Dugdale,  shows  the  gathering  forces  of  varied  neuroses  when  fos- 
tered by  heredity  and  environment  through  more  than  a  hundred 
years.  Here  1,200  persons,  the  descendants  of  five  degenerate  sis- 
ters, repeat  in  successive  generations  the  tale  of  disease,  insanity, 
idiocy  and  crime,  reversion  to  original  type  or  its  escape  through 
early  death. 

In  these  we  have  surely  found  evidence  in  support  of  the  theory 
advanced,  that  the  transmission  of  imbecility  is  at  once  the  most  in- 
sidious and  the  most  aggressive  of  degenerative  forces ;  attacking 
alike  the  physical,  mental  and  moral  nature,  enfeebling  the  judgment 
and  will,  while  exaggerating  the  sexual  impulses  and  the  perpetua- 
tion of  an  evil  growth,  a  growth  too  often  parasitic ;  ready  to  unite 
with  any  neurosis  it  may  encounter,  and  from  its  very  sluggishness 
and  inertia  refusing  to  be  shaken  off;  lying  latent  it  may  be,  but 
sure  to  reappear,  as  Haller  recounts,  through  a  century  to  the  fourth 
and  fifth  generation. 

It  is  this  permeating,  penetrating,  disintegrating  power  that  to  my 
mind  places  idiocy  as  a  cause  distinct  from  insanity ;  nor  do  I  see  why 
so  many  in  pursuing  the  study  of  etiology  class  them  together.  One 
is  mental  defect,  and  the  other  mental  disease ;  and  although  closely 
approximating  in  the  peculiar  phases  of  excitable  idiocy  and  demen- 
tia, nevertheless  they  are  distinctly  different  in  both  general  states  and 
general  effects,  proofs  of  which  are  found  in  the  enfeebled  constitu- 
tion and  early  death  period  of  the  imbecile,  as  contracted  with  the 
average  death  record  and  longevity  of  the  insane. 

Phthisis  appears  prominently  as  a  cause,  second  in  the  English 
table — 674  or  28.31  per  cent.,  and  third — 231  or  7.57  per  cent,  in 
the  American,  and  its  importance  is  confirmed  by  other  authorities. 

Langdon  Down  finds  in  his  cases  a  marked  history  of  phthisis  in 
25  per  cent,  of  the  fathers  and  in  20  per  cent,  of  the  mothers. 

Wallington  Grabham  specially  examined  249  cases,  and  in  55,  or 


ETIOLOGY.  IO3 

22  per  cent,  there  was  a  history  of  phthisis  in  the  parents  or  near 
relatives. 

Kerlin  gives  consumption  as  a  possible  factor  in  56  per  cent,  of  the 
families  of  the  cases  he  examined. 

Carson  found  the  father  consumptive  in  4,  and  the  mother  in  11 
cases  out  of  1,000. 

Rogers  does  not  give  phthisis  as  an  actual  cause,  but  he  finds  it 
occurring  in  49  families — 9.8  per  cent. 

Piper  found  phthisis  in  parents  or  near  relatives  in  23  per  cent. 

The  immediate  effect  of  phthisis  upon  the  strongest  constitution 
is  a  lowering  of  tone  and  a  lessening  of  all  the  physical  forces  ;  but  in 
enfeebled  constitutions  it  cooperates  readily  with  any  neuroses  patent 
or  latent,  in  the  work  of  disintegration  and  tearing  down  of  tissue, 
nerve  and  fibre,  inducing  an  enfeebled  condition  utterly  unsuited  to 
healthful  procreation.  It  is  this  general  poverty  of  the  whole  being 
which  chiefly  characterizes  the  victims  of  a  phthisical  heredity,  and 
which  is  more  to  be  dreaded  than  the  inheritance  of  the  actual  dis- 
ease, in  so  much  as  such  a  condition  is  favorable  to  the  development 
of  idiocy  either  congenital  or  accidental. 

Here  we  arrive  at  a  common  point  of  departure  in  our  three  pri- 
mary causes — abnormal  condition  of  mothers  during  gestation,  he- 
redity of  imbecility,  and  heredity  of  phthisis — i.  e„  that  the  influence 
of  each  and  all  tends  to  a  complete  physical  degeneracy  in  which 
mental  degeneracy  finds  logically  its  natural  abode.  Thus  in  appar- 
ent divergence  do  our  tables  show  actual  convergence  in  their  esti- 
mate of  the  primary  causes  inducing  idiocy ;  a  view  confirmed  in  the 
results  of  the  researches  of  the  various  authorities  cited,  made  on 
different  lines. 

Insanity  reproducing  itself,  is  a  fact  as  unquestioned  as  that  of  its 
frequency  as  a  contributing  cause  to  many  forms  of  degeneration. 
As  a  sole  agent  Koch  considers  it  less  active  than  imbecility,  finding 
in  his  studies  16  per  cent,  of  the  former  as  contrasted  with  24  per 
cent,  of  the  latter,  and  my  researches  confirm  his  opinion,  showing 
insanity  a  predominating  cause  in  216  cases,  or  only  7.08  per  cent. 

Associated  with  other  neuroses,  more  especially  idiocy,  phthisis  or 
epilepsy,  it  lends  a  psychologic  force  almost  certain  to  develop  men- 
tal defect.     Beach  and  Shuttleworth  find  this  grouping  in  392  or 


1 04  ETIOLOGY. 

16.47  Per  cent,  of  their  cases,  and  Carson  in  a  study  of  1,000  cases 
enumerated  this  factor  8  times  in  just  such  association  producing 
132  imbeciles. 

Rogers  finds  8  in  156  cases,  or  5.12  per  cent.  The  Connecticut 
Commission  finds  14  in  164  cases,  or  8.53  per  cent.,  and  Howe  finds 
261  in  574  cases,  or  45.47  per  cent.  These  approximate  closer  to 
the  American  than  to  the  English  table.  Ludvig  Dahl  in  his  re- 
searches arrives  at  very  different  conclusions,  for  out  of  169  idiots 
he  finds  84  with  insane  relatives  giving  a  collateral  heredity  of  in- 
sanity, or  almost  50  per  cent;  whereas  of  151  who  had  become  in- 
sane only  58  or  38.41  per  cent  showed  similar  heredity. 

Kerlin  found  10  per  cent,  with  an  insane  heredity,  and  Down  finds 
a  history  of  heredity  of  insanity  in  16  per  cent,  on  the  father's  side 
and  15  per  cent,  on  the  mother's. 

In  my  study  through  seven  generations  of  a  family  numbering  173 
individuals  I  have  traced  25  pronounced  neurotics,  9  insane,  3  im- 
becile, 3  epileptic  and  10  still-born  children ;  in  all  50  abnormal  de- 
scendants of  one  insane  man. 

A  low-grade  imbecile  girl  is  the  only  child  of  insane  parents  who, 
from  over-wrought  superstitious  belief  in  signs  and  omens,  became 
subject  to  delusions  of  witchcraft. 

Intemperance,  of  which  the  English  table  gives  390  or  16.38  per 
cent,  and  the  American  136  or  4.46  per  cent.,  while  a  recognized 
contributing  factor,  is  in  my  opinion  greatly  exaggerated  above 
others  with  which  it  is  not  infrequently  found  associated,  nor  do 
statistics  verify  the  deductions  made  regarding  its  potency  as  a  sole 
agent  in  the  production  of  idiocy.  The  diametrically  opposite  views 
entertained  by  Down  and  Ireland  are  each  so  well  sustained  by  ex- 
amples as  to  make  a  comparison  most  interesting.  Langdon  Down 
says :  "  I  feel  quite  sure  that  drunkenness  must  be  placed  among  the 
factors  in  the  production  of  idiocy.  ...  In  cases  where  the  fathers 
were  never  very  drunk  yet  never  perfectly  sober  .  .  .  the  chronic 
alcoholism  had  produced  a  condition  of  mental  hebetude  from  the 
slow  poisoning  to  which  they  were  subjected.  Some  of  the  cases 
are  the  result  of  slow  deterioration  of  the  father's  mental  and  physical 
powers,  others  are  the  result  of  procreation  having  taken  place  during 
a  debauch,"  and  he  adds  as  concurrent  testimony :  "  Dr.  Elam  states 


Plate  XVI 


ETIOLOGY.  105 

in  '  A  Physician's  Problem,'  that  on  the  removal  of  the  spirit  duty 
in  Norway  insanity  increased  50  per  cent,  and  congenital  idiocy  150 
per  cent.  Dr.  Ruez  has  observed  that  idiocy  was  very  common 
among  the  miners  of  Westphalia,  who,  living  apart  from  their  wives, 
only  came  home,  and  generally  got  drunk,  on  their  holidays.  Dr. 
Delasiauve  says  that  in  the  village  of  Careme,  whose  riches  were  its 
vineyards,  the  inhabitants  were  forced  to  be  a  little  more  sober  in 
consequence  of  ten  years'  vine  disease.  This  he  says  had  a  sensible 
effect  in  diminishing  the  cases  of  idiocy." 

Ireland  is  "  inclined  to  believe  that  drunkenness,  especially  as  a 
sole  cause,  is  not  so  important  a  factor  as  writers  like  Dahl  and 
Down  would  have  us  believe,"  and  goes  on  to  say :  "  I  know  it  to  be 
very  common  in  some  places  where  idiocy  is  scarcely  met  with. 
Those  who  assign  so  much  to  intoxication  during  conception  ought 
to  be  able  to  show  that  a  much  larger  proportion  of  idiots  are  born 
at  certain  times.  In  Scotland  many  of  the  lower  classes  get  drunk 
at  the  New  Year  time — whole  villages  at  once.  We  might  then  ex- 
pect a  larger  proportion  of  idiot  children  to  be  born  about  the  begin- 
ning of  October,  or  nine  months  after  the  men  came  back  from  the 
herring  fishing,  when  they  generally  have  a  carouse.  This  no  one 
has  noticed.  As  to  the  stress  laid  upon  drunkenness  at  the  time  of 
conception  Jules  Voisin  thinks  that  this  cause  is  reinforced  by  the 
terror  or  repulsion  of  the  mother.  Since  Dahl  wrote  his  work  on 
De  Sindssyge  i  Norge,  now  nearly  forty  years  ago,  we  have  been 
assured  that  there  has  been  a  great  diminution  in  drunkenness  with- 
out any  apparent  decrease  in  the  number  of  idiots.  In  my  opinion 
idiocy  is  not  the  ordinary  legacy  which  drunkards  leave  to  their 
children  ...  at  the  same  time  it  is  not  denied  that  the  toxic  action 
of  alcohol  may  in  some  instances  be  the  direct  cause  of  idiocy." 

C.  T.  Wilbur  of  Illinois  in  365  cases  found  only  8  due  to  intem- 
perance of  parents. 

Howe,  in  an  examination  of  300  idiots,  found  145,  or  nearly  50 
per  cent,  of  the  parents  habitual  drunkards. 

Carl  Looft  finds  only  3.7  per  cent,  in  539  cases,  and  Kind  11  per 
cent,  in  923  cases. 

Rogers  finds  it  singly  in  11  cases,  7.05  per  cent,  out  of  156,  and 
concurrent  in  29  of  344  cases,  or  8.43  per  cent.     Grabham  finds  only 


106  ETIOLOGY. 

6  cases,  and  in  2  of  these  was  a  concurrence  of  insane  heredity. 
Kerlin  gives  38  per  cent.,  and  Carson  finds  199  cases  of  intemperance 
occurring  in  one  or  both  parents,  and  23  cases  in  combination  with 
mixed  neuroses. 

The  Connecticut  Commission  in  235  cases  finds  76  due  to  intem- 
perance of  parents;  46  showing  one,  and  30  both  parents  intem- 
perate. 

Demeaux  in  a  study  of  36  feeble-minded  epileptics  found  that  5 
were  conceived  in  drunkenness. 

Of  691  idiotic  children  examined  in  Gladbach,  61  or  nearly  8.83 
per  cent,  had  intemperate  parents — 57  fathers,  2  mothers  and  2  both. 

I  find  8  striking  examples  of  this  heredity  among  my  patients : 
A  boy,  a  pronounced  moral  imbecile,  was  conceived  in  a  debauch. 

A  brother  and  sister,  low-grade  mutes,  both  possessing  a  rather  re- 
markable talent  for  music — the  brother  especially  exhibiting  wonder- 
ful facility  upon  the  piano;  the  father  was  an  habitual  drunkard. 
Three  microcephalic  idiots — boys — are  the  children  of  a  dipsomaniac ; 
the  mother  is  a  woman  of  average  intelligence. 

The  others  are  two  extreme  types,  an  idiot  who  is  also  a  mute; 
and  an  imbecile  of  high  grade,  a  musical  prodigy.  Both  parents  of 
each  of  these  are  dipsomaniacs. 

In  the  Mechanics'  Institution  at  Manchester,  England,  are  casts  of 
the  heads  of  seven  microcephalic  idiots.  The  father,  a  dipsomaniac, 
kept  a  public  house  and  was  habitually  drunk.  There  is  no  history  of 
the  mother.  Eight  children  were  born ;  of  these  the  first  seven  were 
the  idiots  referred  to,  all  conceived  in  drunkenness.  Later,  loss  of 
business  depriving  him  of  the  means  of  drink,  while  the  father  per- 
force was  sober,  a  child  perfect  in  every  way  was  born. 

Marce  tells  of  a  man  twice  married  who  drank  to  such  excess  as  to 
exhibit  symptoms  bordering  on  insanity.  His  first  wife  bore  sixteen 
children,  fifteen  of  whom  died  of  convulsions  within  a  year  after 
birth ;  one  child,  an  epileptic,  lived.  The  second  wife  had  eight  chil- 
dren of  whom  seven  died  of  convulsions  and  the  survivor  was 
scrofulous. 

Of  epilepsy,  Fere  has  said  that  no  neuropathic  disease  is  more 
directly  transmitted,  but  a  glance  at  statistics  proves  it  certainly  not 
so  frequent  as  others,  except  in  combination  where  it,  like  insanity, 
proves  a  powerful  coadjutor  in  the  production  of  mental  defect. 


ETIOLOGY.  IO7 

I  found  but  3.02  per  cent.,  and  Rogers  1.2  per  cent. 

Down's  9  per  cent. — 3  per  cent,  of  fathers  and  6  per  cent,  of 
mothers — approximates  closely  Beach  and  Shuttleworth's  8.69  per 
cent.  Carson  finds  it  in  combination  in  124  cases  giving  12.40  per 
cent.,  and  affirms  that  in  his  experience  he  has  never  found  it  alone ; 
and  Gowers  reports  a  history  of  insanity  and  epilepsy  in  one-third  of 
1,450  cases  examined  by  him,  or  33.33  per  cent. 

Kerlin's  16  per  cent,  was  doubtless  also  in  combination  with  other 
neuroses. 

Eccheverria  gives  the  largest  report  of  transmission  direct  from 
parents ;  39  per  cent,  of  572  epileptics,  which  goes  far  to  confirm 
Fere's  opinion. 

I  am  inclined  to  regard  epilepsy  as  much  a  phase  as  a  contributing 
cause.  The  result  of  its  association  with  any  of  the  predominating 
hereditary  causes  referred  to,  even  though  indirect  or  collateral,  is  in- 
evitable; the  comparative  infrequency  of  cases  of  direct  transmis- 
sion is  doubtless  due  to  the  force  of  public  opinion  forbidding  mar- 
riage or  preventing  cohabitation. 

In  speaking  of  epilepsy  as  a  phase,  the  meaning  I  would  convey 
is  that  epilepsy,  whether  associated  with  profound  idiocy  or  extra- 
ordinary genius,  is  an  abnormal  condition  in  which  constant  mental 
deterioration  goes  on — a  deterioration  often  unrecognized  before 
death  intervenes. 

In  the  minor  neuroses  are  included  all  those  unstable  conditions  of 
nerve  centers  easily  reacting  upon  any  occasion  either  of  excitement 
or  of  depression;  exhibited  often  in  severe  nerve-storms,  attacks  of 
sudden  uncontrolled  grief  or  anger,  yielding  in  fact  to  any  emotional 
excitement.  Evidenced  at  first  in  violent  expressions  of  temper,  ill- 
regulated  grief  or  untimely  mirth,  this  condition  may  either  in  the 
individual  himself  or  in  his  immediate  descendents,  degenerate  into 
habitual  irritability  or  morbid  sullenness.  There  may  be  chorea, 
hysteria,  sick-headaches  or  cephalalgia,  neuralgias,  hypochondriasis, 
cerebral  diseases,  paralysis  and  various  forms  of  neurotic  diathesis 
which  predispose  to  and,  often  intensified  in  transmission,  produce 
mental  defect. 

Zola,  in  his  long  series  of  novels,  Les  Rougons-Macquart,  ending 
with  Dr.  Pascal,  gives  a  fine  demonstration  of  the  psychologic  family 


108  ETIOLOGY. 

history  of  a  Provencal  family  affected  by  hereditary  neuroses  nearly 
all  of  whose  members  show  some  inherited  cerebral  taint.  This  is 
the  history  of  five  generations  of  neurotics  descended  from  one 
neurotic  ancestor ;  ill-defined  psychoses  appear  first,  succeeded  by 
definite  psychoses,  then  by  nerve  scleroses,  with  the  final  extinction 
of  the  family  except  where  there  is  an  admixture  of  healthy  blood. 

Weakened  power  of  resistance  leads  to  a  lowering  of  moral  tone, 
as  indicated  by  indulgence  in  petty  vices,  irresponsibility  or  conse- 
quent inability  to  attain  success  in  life ;  such  constitutions  encounter- 
ing and  commingling  with  other  neuroses,  are  almost  sure  to  develop 
idiocy  or  imbecility  in  offspring. 

Kerlin  gives  under  this  head  35  per  cent,  of  parents  nervously  dis- 
ordered and  6  per  cent,  paralyzed. 

Rogers  found  16  cases,  or  3.2  per  cent.,  the  result  of  varied 
neuroses. 

Beach  and  Shuttleworth  find  11.30  per  cent,  and  I,  79  or  2.58  per 
cent,  due  to  the  minor  neuroses.  In  Canton  Berne,  Switzerland,  55 
per  cent,  of  idiocy  was  caused  by  the  same. 

Down  says  that  17  per  cent,  of  his  cases — 4  per  cent,  of  fathers 
and  13  per  cent,  of  mothers — had  a  neurotic  history. 

Among  my  patients,  2  little  microcephalic  idiots  are  examples 
of  this  heredity;  the  father  subject  to  intense  sick-headache  and  the 
mother  extremely  nervous. 

The  history  of  the  Farr  family,  which  I  have  traced,  shows  the 
father  fairly  intelligent — the  mother  a  neurotic,  nervous,  flighty  and 
passionate.  Of  a  family  of  7  children,  3  sons  and  1  daughter  were 
normal,  and  1  son  and  2  daughters  imbecile.  The  imbeciles  fortu- 
nately did  not  marry.  The  3  normal  sons  intermarried  with 
good  stock.  The  first  had  1  imbecile  daughter.  The  second  son 
had  5  children,  of  whom  2  apparently  were  normal,  2  died  in  in- 
fancy and  1  daughter  was  a  pronounced  imbecile.  The  third  son 
also  had  5  children,  presumably  normal,  of  whom  2  died  early.  The 
normal  daughter  married  a  healthy  man  and  had  1  imbecile  daughter. 

Herein  we  trace  in  18  descendants  of  one  neurotic :  6  imbeciles 
and  4  early  deaths.  It  is  interesting  to  note  that  the  neurosis  with 
one  exception  is  repeated  in  the  sex  of  the  progenitor. 

The  consensus,  which  accepts  heredity  as  a  primary  active  agent 


Plate  XVII 


Case  F.  Case  G. 

IMBECILES—  HIGH-GRADE. 


ETIOLOGY.  1 09 

in  the  production  of  idiocy,  fails  to  recognize  consanguinity  as  a  dis- 
tinct and  separate  cause  and,  with  but  few  exceptions,  rejects  the 
theory  of  ill  in  consanguineous  marriages  except  when  associated 
with  hereditary  taint. 

The  result  of  this  doubling  and  intensifying  of  neuroses  may  have 
led  to  a  confounding  of  cause  and  effect,  and  this,  influenced  by  the 
insistence  of  certain  medical  writers,  from  time  to  time,  has  tended 
doubtless  gradually  to  create  the  ban,  ecclesiastical,  civil  and  social, 
among  peoples  in  these  latter  days.  Yet  there  seems  a  concurrence 
in  the  opinion  that  "  the  way  in  which  the  subject  has  been  discussed 
and  the  danger  enforced  has  been  too  indiscriminate  and  illogical " 
(Tuke),  and  cannot  be  sustained  by  dataJ3as  many  of  the  cases  cited 
gave  appalling  results,  without  referring  to  the  neurotic  family  his- 
tory, which  really  returns  them  to  their  proper  causation  of  heredity ; 
as  does  Dr.  Howe,  who  reports  44  idiots  in  17  families,  the  parents 
being  scrofulous  and  intemperate,  as  well  as  near  of  kin. 

Ireland,  Voisin,  Bourneville,  and  Bertillin  all  agree  that  consan- 
guineous marriages  are  not  harmful  unless  there  be  distinct  neurosis 
in  the  family,  and  a  consensus  becomes  evident  in  reviewing  the  com- 
paratively small  percentages  of  results  as  given  by  various  authorities, 
thus  :  Down,  7  per  cent. ;  Kerlin,  7  per  cent. ;  Grabham,  6  per  cent. ; 
Rogers,  3.6  per  cent.;  Brown,  3.5  per  cent.,  and  C.  T.  Wilbur,  0.3  per 
cent. 

Beach  and  Shuttleworth  find  in  the  consideration  of  their  100  cases 
giving  4.20  per  cent.,  that  the  bad  effects  are  due  rather  to  the  "  in- 
tensification of  bad  heredity  common  to  both  parents."  In  my  own 
cases,  numbering  only  41  or  1.34  per  cent.,  two  were  the  "results  of 
incestuous  connection — one  of  brother  and  sister,  the  other  of  father 
and  daughter — and  in  the  others  there  was  an  undoubted  history 
of  grave  neuroses. 

Both  Down  and  Kerlin  recognize  that  the  cases  studied  by  them 
were  subject  to  other  and  prior  influences,  and  Down  admits  further 
that  in  but  1  of  20  unselected  cases  that  he  presented,  was  consan- 
guinity the  single  discernible  factor,  and  adds :  "I  have  endeavored 
to  show  that  while  the  marriage  of  cousins  insures  a  degenerate  off- 
spring where  there  is  something  morbid  in  the  family  history — where 
phthisis,  scrofula,  and  especially  the  neuroses  exist — I  am  by  no 


tlO  ETIOLOGY. 

means  sure  that  by  a  judicious  selection  of  cousins  the  race  might  not 
be  improved." 

Arthur  Mitchell  found  that  of  711  idiots  98,  or  13.78  per  cent., 
were  the  offspring  of  blood  relations :  first  cousins  in  42  instances ; 
second  cousins  in  35 ;  third  cousins  in  21.  In  84  cases  no  information 
could  be  obtained.  In  contrast  to  this  he  places  the  percentage  of 
consanguineous  marriages  in  Scotland  at  1.3  per  cent. 

His  views  are  in  harmony  with  those  of  Withington,  who  regards 
morbid  inheritance,  rather  than  specific  degenerative  tendencies,  the 
cause  for  the  unfortunate  conditions  found  in  the  children  of  those 
near  of  kin. 

Alfred  Huth,  in  his  book,  The  Marriage  of  Near  Kin,  says  that 
data  on  this  subject  is  misleading  and  very  defective,  and  that  con- 
sanguinity has  nothing  to  do  with  the  question  if  there  is  no  family 
taint;  therefore  that  marriage  between  members  of  healthy  families 
is  devoid  of  harmful  result. 

George  Darwin,  after  an  exhaustive  investigation  states  that  in 
England,  among  the  upper  classes,  about  4  per  cent,  of  all  marriages 
are  between  first  cousins,  in  the  rural  districts,  between  2  and  3  per 
cent.,  and  in  London,  iJ/2  per  cent. ;  3  per  cent,  is  probably  the  maxi- 
mum, and  of  these  between  3  and  4  per  cent,  of  the  children  are 
idiots.  The  conclusion  he  arrives  at  is  that,  "the  widely  different 
habits  of  life  of  men  and  women  in  civilized  nations,  especially 
among  the  upper  classes,  tend  to  counterbalance  any  evil  from  mar- 
riage between  healthy,  closely  related  persons." 

These  views  are  sustained  by  the  statistics  of  such  marriages  col- 
lected by  M.  Voisin  in  the  commune  of  Batz. 

"  Among  this  population  46  marriages  took  place  between  cousins, 
viz.,  5  between  cousins-german,  31  between  cousins  of  the  next  de- 
gree below,  10  between  cousins  of  the  next  again.  The  issue  of  the 
5  were:  23  children  free  from  all  constitutional  disease,  2  only 
having  died  of  casual  disorders.  The  issue  of  the  31  were  120  chil- 
dren, none  of  whom  labor  under  any  constitutional  infirmity,  24 
having  died  of  acute  disorders.  The  issue  of  the  10  were  29  chil- 
dren, all  born  healthy,  3  having  died  of  accidental  diseases.  Two 
females  were  sterile,  the  parents  being  related  in  the  third  degree. 
Insanity,  idiocy,  and  deaf-mutism  are  unknown." 


ETIOLOGY.  Ill 

Batz  is  an  isolated,  ocean-washed  peninsula  of  the  Loire  Inferieure, 
France,  containing  3,300  inhabitants,  who  lead  simple  lives,  and 
among  whom  crime  and  intemperance  are  unknown.  For  many  gen- 
erations they  have  intermarried,  but  no  cases  of  degeneration  have 
occurred,  and  the  number  of  children  born  is  above  the  average. 

Voisin,  in  a  further  study  of  1,077  children  at  the  Bicetre  and 
Salpetriere,  reports  that  in  not  one  case  could  he  find  consanguinity 
a  cause  of  mental  deficiency. 

Mr.  Amos  Bonsall,  the  sole  survivor  of  the  Kane  expedition,  tells 
me  that  the  Eskimos  of  North  Greenland  living  within  an  area  of  250 
miles  have  intermarried  for  years,  and  yet  imbecility  and  even  con- 
genital physical  defect  is  unknown  among  them.  Huth  also  reports 
a  similar  condition  existing  in  the  isolated  communities  of  Pitcairn 
and  Iceland,  and  the  same  is  known  to  obtain  among  North  American 
Indians  and  South  Sea  Islanders,  where  mental  defect  is  the  ex- 
ception. 

Howe's  inquiry  into  the  parentage  of  359  idiots,  finds  in  17  families 
or  4.74  per  cent.,  parents  nearly  related;  in  1  of  these  there  were  5 
idiotic  children ;  in  5  families  4  idiots  each  were  born ;  in  3  families, 
3  each;  in  2  families,  2  each;  and  in  6  families,  1  each:  in  all  95 
children  of  whom  44  were  idiots,  12  scrofulous  and  puny,  1  deaf,  1 
dwarf,  58  in  low  health  or  defective,  and  only  37  fairly  healthy. 
He  adds  that  one  or  both  of  the  parents  were  either  intemperate  or 
scrofulous,  and  that  there  were  also  other  predisposing  causes. 

Esquirol  says  that  it  is  well-nigh  impossible  to  estimate  the  num- 
ber of  French  nobles  who  are  defective  as  the  result  of  the  inter- 
marriage of  relatives  ;  and  a  similar  statement  is  made  of  the  Catholic 
families  of  Scotland  and  England,  as  also  of  the  Spanish  branch  of 
the  house  of  Austria.  It  is,  however,  an  undisputed  fact  that  in  all 
of  these  families,  there  was  an  heredity  of  imbecility,  insanity  and 
other  neuroses. 

Bemiss,  who  has  perhaps  made  the  most  exhaustive  study  of  this 
subject  on  record,  reports  833  consanguineous  marriages,  giving  the 
time  of  marriage,  the  occupation,  the  temperament,  the  health,  habits, 
etc.,  of  the  parents,  with  the  number  of  children,  their  defects,  pecu- 
liarities, etc.  The  degree  of  relationship  in  these  cases  is  given  thus : 
10  marriages  between  brother  and  sister  or  parent  and  child ;  12  be- 


112  ETIOLOGY. 

tween  uncle  and  niece  or  aunt  and  nephew;  61  between  blood-rela- 
tions, who  were  themselves  the  descendants  of  blood-relations;  27 
between  double  first  cousins ;  600  between  first  cousins ;  120  between 
second  cousins;  and  13  between  third  cousins. 

The  proportion  reported  deaf  and  dumb,  blind,  idiotic,  scrofulous, 
and  deformed  is  altogether  larger  than  would  be  found  among  the 
children  of  families  in  the  community,  taking  them  indiscriminately. 

The  entire  number  of  children  springing  from  these  833  marriages 
was  3,942,  of  whom  1,134  were  defectives:  145  deaf  and  dumb;  85 
blind;  308  idiotic;  38  insane;  60  epileptic;  300  scrofulous;  98  de- 
formed; and  883  died  in  infancy.  These  statistics  appear  appalling 
in  view  of  what  this  intensified  current  may  achieve  in  the  carrying 
forward  of  defect,  latent  though  it  might  be  for  generations.  But 
interesting  as  they  may  be,  these  facts  do  not  prove  that  consan- 
guinity alone  is  accountable  for  all ;  as  it  cannot  be  doubted  but  that 
intemperance  and  immorality  in  some  parents,  and  various  inherited 
neuroses  in  the  families,  often  intensified  by  incestuous  connection, 
had  a  large  share  in  the  production  of  these  defectives. 

Incest,  frequent  among  the  Egyptians  and  Persians,  and  later 
among  the  Athenians  and  Spartans,  was  condemned  by  Socrates  who 
spoke  of  such  intercourse  as  pre  judical  to  the  healthy  propagation 
of  species. 

The  Mohammedans,  although  practicing  polygamy,  are  shocked 
at  such  intermarriages.  The  Koran  has  this  remarkable  passage: 
"  Ye  are  forbidden  to  marry  your  mothers,  and  your  daughters,  and 
your  sisters  and  your  aunts,  both  on  the  father's  and  on  the  mother's 
side;  and  your  brother's  daughters  and  your  sister's  daughters,  and 
your  foster  sisters  and  your  wives'  mothers,  and  your  daughters-in- 
law  who  are  under  tuition,  and  the  wives  of  your  sons;  and  ye  are 
also  forbidden  to  take  to  wife  two  sisters." 

After  thus  considering  data  and  argument  on  both  sides,  it  be- 
comes evident  that  a  baneful  heredity  is  the  source  of  ill  and  not  mere 
consanguinity,  which  is  but  heredity  intensified. 

Having  reviewed  the  primary  and  more  frequent  hereditary  causes 
of  mental  defect,  we  come  to  those  not  so  general  in  character.  Not 
only  are  these  latter  less  frequent  and  less  pronounced,  but  they  may 
even  be  remotely  traceable  to,  if  not  the  direct  result  of,  the  former. 


ETIOLOGY.  II3 

Thus  scrofula,  cancer,  goiter,  and  even  the  diseases  of  the  cardio- 
vascular system,  not  appearing  at  all  in  the  English  table,  present 
in  the  American  a  marked  diminution  in  figures  :  Scrofula  36  cases — 
1. 18  per  cent.;  cancer  25 — .82  per  cent.;  goiter  2 — .07  per  cent.,  and 
diseases  of  the  cardio-vascular  system,  18 — .59  per  cent.  Fewer 
cases  and  smaller  percentages,  show  these  either  so  rare  or  of  such 
minor  importance,  as  almost  to  be  classed  not  so  much  as  direct 
causes  as  secondary  predispositions  in  heredity — certain  physiologic 
conditions  so  to  speak. 

Scrofula,  a  very  vague,  unsatisfactory  term,  and  not  at  all  com- 
prehensive, is  a  peculiar  form  of  perverted  nutrition  or  rather  a  mal- 
nutrition tending  to  retard  development  of  the  nerve  centers,  and  is 
closely  allied  to  phthisis ;  only  the  discrasia  in  this  manifests  itself 
by  frequent  eruptions,  furuncles,  ulcers,  repeated  attacks  of  coryza, 
otorrhcea,  ophthalmia,  glandular  swellings,  flabby  flesh,  inflamed 
eyelids,  red,  spongy  gums,  etc.  Persons  so  affected  are  never  very 
sick,  and  on  the  other  hand  never  very  well,  and  such  heredity  must 
be  always  wholly  or  in  part  defective.  Inheritors  of  a  scrofulous 
diathesis  do  not  always  develop  genuine  phthisis,  but  are  subject  to 
intermittent  attacks  of  uremia,  pneumonia,  epilepsy  and  affections 
of  the  liver,  and  readily  succumb  to  any  acute  disease.  General 
statistics  here  coincide;  for  although  Howe  found  419  idiots  of  de- 
cided scrofulous  condition,  and  according  to  Ireland  two-thirds  if 
not  more  of  all  idiots  belong  to  that  class,  these  are  of  course  refer- 
able to  phthisis.  Rogers  finds  scrofula  only  once  as  an  assigned 
cause,  but  associated  with  other  neuroses  in  46,  or  9.2  per  cent,  of 
his  cases. 

Similarly  does  cancer  evidenced,  more  generally  by  inward  rather 
than  by  surface  growth,  in  a  general  tearing  down  and  enfeeble- 
ment  of  the  whole  constitution,  predispose  to  mental  degeneracy, 
being  itself,  however,  as  is  also  goiter,  as  much  the  result  as  the 
producer  of  malnutrition.  Of  these,  statistics  are  fewer  still.  Down, 
who  finds  cancer  in  3  per  cent,  of  the  fathers  and  5  per  cent,  of 
the  mothers,  considers  it  a  factor  of  minor  importance ;  while  of 
goiter  he  gives  still  less,  2  per  cent,  in  the  mothers,  and  Rogers,  only 
.6  per  cent. 
8 


114  ETIOLOGY. 

Diseases  of  the  cardio-vascular  system  exhibiting  fatty  infiltration 
or  degeneration,  or  valvular  diseases  combined  with  kidney  trouble, 
are  not  infrequently  traceable  to  an  heredity,  however  remote,  of 
insanity,  imbecility  or  alcoholism,  and  fall  in  the  same  category  of 
malnutritive  causes.  The  mixed  neuroses  here  combining  to  estab- 
lish an  enfeebled  circulatory  system,  degeneration  both  physical  and 
mental  becomes  inevitable. 

Syphilis  as  a  factor  in  the  etiology  of  idiocy  holds  a  very  unim- 
portant place,  and  all  authorities  in  finding  it  comparatively  rare, 
unite  in  the  opinion  that  owing  to  natural  reticence,  information 
under  this  head  is  not  readily  obtainable.  Grabham  gives  no  statis- 
tics, but  says :  "  Syphilis  in  parents  may  account  for  a  few  cases  as  I 
have  seen  well-marked  secondary  syphilis  in  several  of  the  children 
under  my  care."  Ireland,  who  also  gives  no  statistics,  says :  "  I 
myself  have  met  with  but  a  few  instances  in  which  this  malady 
appeared  to  have  been  the  cause  of  idiocy."  John  Thompson  (Edin- 
burgh) has  seen  a  few  cases  of  mental  defect  accredited  to  syphilis, 
but  he  too  gives  no  statistics.  iLangdon  Down  and  Kerlin  each 
find  it  in  2  per  cent.;  Shuttleworth  and  Beach  in  1.17  per  cent. 
The  6  cases  giving  .20  per  cent,  which  I  find,  are  however  undoubt- 
edly attributable  to  syphilis,  the  family  histories  being  clear  of  neu- 
rotic taint. 

A  hydrocephalic  idiot  with  prematurely  aged  face,  fissured  lips 
(rhagades),  Hutchinson's  teeth,  rudimentary  nose  and  osseous 
lesions,  is  one  of  a  family  of  5  children  all  suffering  from  congenital 
syphilis  which  the  father,  a  literary  man  and  prominent  in  church 
circles,  had  contracted  in  his  early  manhood.  He  told  how,  after  the' 
excitement  of  a  wine-party,  he  had  drifted  into  the  "  gates  of  hell  " ; 
how  concealing  his  infection  he  had  sought  the  aid  of  charlatans,  and 
how  finally,  on  the  strength  of  an  opinion  that  he  was  cured  and  need 
have  no  further  anxiety,  he  had  married ;  only  to  suffer  untold  agony 
in  witnessing  the  mental  and  physical  ruin  of  wife  and  children. 

In  another  case  the  child  is  idiotic  and  blind.  In  another,  the 
child  is  idiotic  and  frightful  to  look  upon. 

A  semi-mute,  paralyzed  and  epileptic,  the  ninth  of  ten  concep- 
tions ;  all  save  this  one  were  either  aborted  at  the  seventh  month,  or 
were  born  "  blue  babies,"  and  died  soon  after  birth.  The  father,  an 
imbecile,  was  literally  eaten  up  with  syphilis. 


ETIOLOGY.  I  I  5 

In  another,  a  member  of  an  aristocratic  Hebrew  family,  the  result 
of  the  father's  early  errors  is  evidenced  in  imbecility,  epilepsy,  pegged 
and  notched  teeth,  keratitis,  and  phagedenic  ulcerations. 

A  choreic,  paralyzed  girl  bears  upon  her  feeble  mind,  and  yet  more 
feeble  body,  the  effects  of  the  sins  of  a  father  who,  brilliant  and 
talented,  the  pride  of  an  old  family,  had  once  been  accounted  an 
ornament  to  the  bar  and  one  of  the  most  promising  men  of  his  state. 
A  short  time  since,  he  died  after  a  lingering  illness,  his  body  covered 
with  disgusting  sores  and  a  gumma  in  his  brain;  his  victims,  this 
girl  and  a  widow  whose  skin  is  scarred  with  the  marks  of  syphilis. 

Attempted  abortion  as  a  cause,  greatly  exaggerated,  finds  little  or 
no  verification  in  statistics,  and  even  should  idiocy  follow  it  would 
be  doubtless  referable  to  those  maternal  conditions  already  cited. 
Certainly  no  woman  so  far  below  the  brutes  as  such  an  act  would 
indicate  is  in  normal  condition. 

Howe  reports  7  idiots  whom  he  claims  were  the  results  of  at- 
tempted abortion,  I  but  2,  and  Rogers  1.  Beach  and  Shuttleworth 
find  no  evidence  that  they  consider  reliable ;  nor  does  Down,  who 
adds :  "  It  is  said  to  be  a  cause  but  I  am  not  able  from  my  per- 
sonal experience  to  confirm  or  negative  the  statement." 

In  the  second  division — the  causes  acting  at  birth — the  two  tables 
coincide  more  or  less ;  with  the  difference  that  the  Elwyn  table  does 
not  include  primogeniture,  of  which  the  English  table  records  492, 
or  20.67  Per  cent.,  modified  by  the  statement  that  there  are  probably 
other  contributing  causes. 

The  various  influences  retarding  or  complicating  delivery  are  of 
minor  importance  compared  with  either  those  just  reviewed,  as  acting 
before  birth,  or  the  results  of  accidents  or  disease  developing  after 
birth,  as  our  figures  show. 

Premature  birth  is  3.52  per  cent,  in  the  English  table  against  1.12 
per  cent,  in  the  American,  while  Rogers  finds  it  in  only  0.2  per  cent. 

Difficult  labor  whether  tedious  or  prolonged;  protracted  pressure 
due  to  narrow  pelvis  or  rigidity  of  the  perineum,  etc.,  is  found  a 
cause  more  frequent  by  Beach  and  Shuttleworth  who  give  14.24  per 
cent.,  but  of  this  I  find  only  18  cases,  or  .59  per  cent,  and  Rogers  not 
more  than  5  cases,  or  1  per  cent.     Down  gives  no  statistics,  but  the 


Il6  ETIOLOGY. 

opinion  that  prolonged  detention  of  the  child  in  the  maternal  pas- 
sages is  an  important  factor. 

Accidents  during  birth,  such  as  death  of  the  mother,  injury  to  the 
child's  head  by  precipitated  birth,  and  hemorrhage  from  the  um- 
bilical cord,  may  be  causes.  Here  also  I  find  only  .59  per  cent., 
Beach  and  Shuttleworth  1.5 1  per  cent.,  and  Rogers  in  .2  per  cent. 

Instrumental  delivery  Grabham  thinks  is  as  a  cause  too  frequently 
underestimated,  yet  in  his  experience  it  amounts  only  to  5.03  per 
cent. ;  Down's  9  per  cent,  is  greater,  while  Beach  and  Shuttleworth's 
3.31,  Rogers'  .2,  and  my  .50  per  cent.,  are  all  less. 

Grabham  feels  that  asphyxia  in  the  newly-born  child  is  an  im- 
portant cause  of  mental  defect,  but  gives  no  statistics,  while  Down 
finds  it  a  factor  in  20  per  cent.  Shuttleworth  gives  it  in  11.7  per 
cent,  in  his  single  experience,  and  Beach  alone  finds  it  in  12.96  per 
cent.,  while  I  have  met  with  only  4  cases,  giving  but  .13  per  cent. 

Ireland  considers  it  not  a  common  cause,  but  admits  that  his  per- 
sonal experience  is  not  very  extensive. 

The  agents  of  the  two  periods  at  and  succeeding  birth — prolonged 
suffering,  asphyxia,  accident,  undue  excitement,  shock,  or  acute  dis- 
ease, etc.,  follow  naturally  the  line  of  least  resistance,  and  if  aided 
rather  than  combated  by  the  forces  of  heredity,  readily  accomplish 
in  the  offspring  that  result  always  threatening  poorly  nourished  con- 
ditions. 

The  third  division — causes  acting  after  birth — in  which  data  is 
more  obtainable  because  more  readily  acknowledged  than  those  of 
congenital  origin,  presents  development  of  mental  defect  from  either 
disease  or  accident  after  birth.  Of  these  causes  the  English  table 
finds  eclampsia  the  most  frequent;  epilepsy  and  cerebral  affections, 
infantile  paralysis,  injuries  to  the  head,  fright  or  shock  and  insola- 
tion, preceding  the  febrile  illnesses. 

The  American  table  finds  in  this  period,  its  chief  causes  in  injuries 
to  the  head,  and  epilepsy  in  which  eclampsia  is  included;  the  acute 
diseases,  scarlatina,  meningitis,  accidents  and  tuberculosis  preceding 
those  of  yet  minor  importance. 

Injuries  to  the  head  approximate  closely  in  the  two  tables,  the 
percentages  showing  6.17,  and  6.26  per  cent.  The  traumata,  usually 
due  to  falls,  blows,  etc.,  may  prove  harmful  in  two  ways ;  directly 


Plate  XIX. 


ETIOLOGY.  I  I  7 

at  the  time  by  concussion,  or  later  by  the  occurrence  of  secondary 
lesions. 

Down,  who  gives  no  statistics,  is  persuaded  that  although  trauma- 
tism in  some  cases  may  prove  harmful,  yet  it  is  not  so  common  a 
cause  as  one  is  frequently  led  to  believe;  furthermore  that  a  large 
number  of  the  cases  of  mental  defect  attributed  to  suspected  falls  are 
really  of  congenital  origin.  Rogers  finds  traumatism  in  10  cases  or 
2  per  cent. 

The  record  of  convulsions  of  infancy — eclampsia — which  the  Eng- 
lish table  places  first  in  its  third  period,  giving  27.39  per  cent,  and 
epilepsy  and  cerebral  affections  8.1 1  per  cent.,  is  modified  by  the 
statement  of  there  being  other  contributing  factors.  I  have  always, 
and  do  here,  class  all  infantile  convulsions  with  epilepsy;  and  daily 
experience  but  tends  to  confirm  the  opinion,  early  reached,  that  so- 
called  eclampsic  convulsions  are  in  reality  true  epilepsy,  and  that 
epilepsy  developing  without  apparent  cause  either  at  puberty,  in 
early  manhood  or  womanhood,  or  at  a  more  advanced  period,  may 
almost  invariably  be  traced  back  to  these ;  showing,  to  my  mind,  the 
epilepsy  to  be  a  recurrent  attack,  and  epileptic  seizures  are  always 
active  agents  of  degeneration.     I  find  epilepsy  in  5.9  per  cent. 

Grabham  finds  convulsions  in  nearly  2  per  cent,  of  his  cases  oc- 
curring soon  after  birth,  or  at  first  dentition,  but  he  considers  that 
in  many  cases  there  are  other  predisposing  causes.  Rogers  gives 
4.8  per  cent,  and  Down,  while  he  mentions  epilepsy  and  convulsions 
as  a  cause,  gives  no  statistics. 

The  136  cases  of  acute  disease  in  the  American  table,  giving  4.46 
per  cent.,  include  such  diseases  as  pneumonia,  pleurisy,  malarial  and 
ephemeral  fevers.  These  being  the  only  causes  assigned,  insufficient 
data  required  their  acceptance,  although  I  feel  well  assured  that  in 
the  majority  of  cases  a  decided  neurotic  heredity  and  lack  of  resisting 
power  was  the  true  cause,  and  the  disease  only  an  exciting  agent ;  the 
until  the  acute  attack  precipitated  its  development, 
mental  defect  may  even  have  been  present,  latent  and  unsuspected, 

Beach  and  Shuttleworth  grouping  their  142  cases  of  febrile  ill- 
nesses, 5.96  per  cent.,  without  giving  separated  percentages,  find 
associated  with  the  majority  of  these,  symptoms  of  acute  brain 
trouble,  and  with  the  remainder,  general  malnutrition  apparently 


I  1 8  ETIOLOGY. 

causing  cerebral  atrophy.  Rogers  finds  acute  disease  as  a  cause 
in  no  cases,  or  22  per  cent. 

Scarlatina  I  find  in  84  cases,  or  2.75  per  cent.,  and  Rogers  in  12,  or 
2.4  per  cent. 

Meningitis  I  find  in  80  cases,  or  2.62  per  cent,  and  Rogers  in  24, 
or  4.8  per  cent.  Down  feels  it  is  a  very  frequent  cause  and  adds 
that  children  contract  febrile  illnesses,  scarlatina,  measles,  diphtheria, 
etc.,  which  are  followed  by  inflammation  of  the  ear,  with  extension  to 
the  membranes  of  the  brain;  or  otitis  may  be  set  up  by  catarrh,  the 
inflammatory  action  extending  from  the  outer  to  the  middle  ear,  or 
from  the  pharynx  by  means  of  the  eustachian  tube.  After  so  severe 
an  illness  the  child,  who  may  previously  have  been  normal,  becomes 
an  imbecile.  According  to  Jastrowitz,  inflammation  of  the  brain 
occasionally  occurs  before  birth — in  utero. 

Grabham  states  that  many  children  born  sound  become  defective 
from  injuries,  illness,  or  shocks,  and  places  12  per  cent,  of  his  cases 
in  the  period  succeeding  birth,  as  results  of  scarlatina,  measles, 
whooping  cough,  typhoid  fever,  injuries  to  head  and  various  other 
accidents. 

Of  my  cases,  51,  or  1.67  per  cent,  are  attributed  to  various  acci- 
dents— exclusive  of  injuries  to  the  head — falls,  blows,  kicks,  and 
shocks  of  various  sorts.  Roger's  cases  number  7,  or  1.4  per  cent. 
Beach  and  Shuttleworth  find  that  fright  or  shock  (mental)  acted 
as  a  cause  in  73  cases,  or  3.06  per  cent. 

Many  very  young  children  of  poor  physique,  even  where  there  is 
no  heredity  of  tuberculosis,  are  susceptible  to  its  attack,  tending  to 
mental  enfeeblement,  degenerating  into  imbecility. 

Tuberculosis  is  found  as  an  attributed  cause  in  39,  or  1.28  per  cent, 
of  my  cases. 

I  find  the  gastro-intestinal  diseases  in  28,  or  .92  per  cent.,  and 
Rogers  in  6,  or  1.2  per  cent. 

The  abuse  of  drugs — opium,  the  bromides  and  the  various  so-called 
soothing  syrups  and  other  narcotics,  given  to  infants,  is  said  to  be  a 
fruitful  cause  of  idiocy,  but  I  trace  it  in  only  25  cases,  or  .82  per 
cent.,  and  Rogers  in  7  cases,  or  1.4  per  cent.  Down  considers  the 
abuse  of  opium  a  possible,  but  not  a  probable  cause  and  one  there- 
fore greatly  exaggerated. 


ETIOLOGY. 


II9 


Measles  I  find  in  24,  or  .79  per  cent,  and  Rogers  in  6,  or  1.2  per 
cent. 

Abuse,  neglect  and  exposure,  as  causes,  are  more  rare  than  is  gen- 
erally believed.  Although  cited  in  20  of  my  cases,  or  .66  per  cent, 
these  were  usually  associated  with  bad  hygienic  surroundings,  in- 
sanity or  intemperance  of  parents.  Rogers  reports  15  cases,  or  3 
per  cent. 

Whooping  cough,  I  find  in  19,  or  .62  per  cent,  and  Rogers  in  7, 
or  1.4  per  cent. 

Contrary  to  the  opinion  prevalent  among  the  laity  I  consider  mas- 
turbation rarely  a  direct  cause  of  idiocy,  finding  it  unassociated  in 
only  18  cases,  or  .59  per  cent. ;  an  opinion  in  which  Grabham  con- 
curs, he  naming  it  a  symptom  rather  than  a  cause.  Rogers  men- 
tions it  in  only  1  case,  or  .2  per  cent.  Down  believes  that  morbid 
sexual  erethism,  too  often  induced  by  nurses  to  quiet  children,  is  a 
tangible  cause  of  mental  defect,  leading  eventually  to  grave  moral 
delinquencies. 

I  find  infantile  paralysis  in  17  cases,  or  .56  per  cent. ;  Beach  and 
Shuttleworth  in  22  cases,  or  .92  per  cent. ;  Down  simply  mentions 
it,  and  Rogers  finds  it  in  3,  or  .6  per  cent. 

Typhoid  fever  I  find  in  16  cases,  or  .53  per  cent.,  and  Rogers  in  6, 
or  1.2  per  cent. 

Of  marasmus  my  14  cases,  giving  .46  per  cent.,  are  the  only  ones 
cited. 

Insolation  shows  an  equal  number  of  cases  in  both  English  and 
American  tables — 13 — but  the  percentages  differ  somewhat,  .54-43. 

Down,  Beach  and  Shuttleworth  find  sunstroke  principally  in  Eng- 
lish children  born  in  India ;  my  own  cases  were  those  who  as  very 
young  infants,  were  neglected  and  exposed  to  the  direct  rays  of  the 
sun. 

I  find  various  spinal  diseases  in  12  cases,  or  .39  per  cent.,  and 
Rogers  in  20  cases,  or  4  per  cent. 

Diphtheria  as  a  cause  is  given  in  8,  or  .26  per  cent,  of  my  cases, 
and  Rogers  finds  it  in  1,  or  .02  per  cent,  of  his. 

La  grippe,  of  which  I  have  3  cases,  or  .09  per  cent.,  others  do  not 
mention. 

Chorea  in  2,  or  .07  per  cent.,  I  find,  and  Rogers  in  2,  or  .4  per  cent. 


1 20  ETIOLOGY. 

Hydrocephalus  is  attributed  in  2  of  my  cases,  or  .07  per  cent, 
and  in  3  of  Rogers,  giving  .6  per  cent.  Down  considers  it  an  actual 
cause  but  gives  no  statistics,  nor  does  Grabham  who  states  more- 
over that  he  finds  it  occurring  usually  in  combination  with  other 
causes. 

Tobacco,  especially  in  the  form  of  cigarettes,  having,  according  to 
popular  notion,  an  important  influence,  lacks  verification.  I  have  a 
record  of  1  case  only,  giving  .03  per  cent.,  and  in  this  there  was  a 
remote  influence  of  congenital  imbecility,  forgotten  by  friends  until 
the  boy  in  his  seventh  year,  began  to  smoke.  I  have  no  doubt  that 
excessive  indulgence  in  this  or  any  vice  causing  over-stimulation  and 
subsequent  enervation,  may  be  conducive  to  the  arousing  of  latent 
neuroses,  just  as  does  over-pressure  during  the  school  period,  of 
which  the  English  table  gives  but  4  cases.  In  this  sense  both,  with- 
out being  actual,  would  certainly  prove  predisposing  causes. 

Similarly  of  other  influences  reported  by  various  authorities  as 
causes,  I  find  no  evidence  in  the  cases  I  have  studied;  thus  Beach 
and  Shuttleworth  attach  but  slight  importance  to  illegitimacy,  find- 
ing it  in  42  cases,  or  1.76  per  cent.  Arthur  Mitchell  says  that  in 
Scotland  it  is  a  not  infrequent  cause.  I  cannot  but  think,  however, 
that  in  this  also,  as  in  that  of  twins  and  of  primiparous  children, 
the  idiocy  is  due  rather  to  anxieties  and  exalted  emotional  states  of 
the  mother. 

Disparity  in  the  age  of  parents  as  a  cause,  my  investigations  also 
fail  to  verify. 

Before  leaving  the  subject  of  etiology,  it  seems  fitting  to  mention 
however  briefly,  "  idiocy  by  deprivation."  As  has  already  been  noted 
many  causes  may  be  resolved  into  the  single  one  of  malnutrition,  and 
may  be  traced  in  mental  as  well  as  in  physical  conditions.  The  lack 
or  loss  of  any  one  sense  avenue  will  preclude  or  arrest  the  develop- 
ment more  directly  dependent  upon  that  one  avenue,  and  the  mind 
suffer  a  certain  starvation,  so  to  speak,  as  in  the  case  of  the  blind 
or  the  deaf-mute — mutism  being  an  acknowledged  example.  True 
it  is  that  other  senses  may  be  so  aroused  as  to  counterbalance  or 
supply  the  loss  of  the  one,  but  when  there  is  lack  of  nerve  force  from 
weakness  engendered  by  causes  either  congenital  or  accidental  this 
fails,  and  idiocy  by  deprivation  ensues.     Such  cases  are  to  be  en- 


Plate  X) 


Case  C.  Case  D. 

MORAL   IMBECILES— LOW-GRADE. 


ETIOLOGY.  I  2  I 

countered  from  time  to  time  in  most  institutions  for  the  blind  and 
deaf-mutes.  In  fact  it  was,  as  stated  in  a  previous  chapter,  the  effort 
to  train  these,  that  first  demonstrated  possibilities  for  all  mental  de- 
fectives, and  the  frequent  applications  of  such  for  admission  to 
training  schools  for  mental  defectives  is  a  proof  of  increasing  num- 
bers in  America.  Of  this  I  have  a  personal  knowledge  through 
many  calls  for  consultation  upon  cases  of  this  character. 

Another  phase  of  this,  what  might  be  termed  "  idiocy  by  isola- 
tion," those  deprived  wholly  of  human  companionship,  is  more  rare, 
there  being  but  scattered  instances  from  those  earliest  recorded  of 
children  nourished  by  beasts,  to  the  notable  one  of  Kaspar  Hauser. 
This  latter,  of  whom  there  seems  to  be  a  division  of  opinion  as  to 
his  being  an  impostor,  or  a  member  of  a  noble  family  disposed  of 
for  reasons,  was  a  young  man  found  in  1828  wandering  aimlessly 
near  one  of  the  gates  of  Nuremberg.  The  single  sentence  "  I  will 
be  a  trooper  as  my  father  was,"  which  he  was  continually  repeating, 
gave  no  clue  to  his  identity  yet  seemed  to  be  his  limit  of  speech. 
Adopted  by  the  city  authorities  and  placed  with  Professor  Daumer, 
he  exhibited  all  the  immaturity  of  a  little  child.  Always  referring 
to  himself  in  the  third  person,  he  told,  as  his  vocabulary  increased, 
of  having  lived  in  a  vaulted  chamber,  his  only  food  bread  and  water, 
placed  beside  him  while  he  slept,  and  of  the  occasional  visits  of  a 
man  who  taught  him  the  phrase  he  had  repeated,  and  to  write  the 
name  Kaspar  Hauser,  and  who  finally  left  him  where  he  was  found. 

Under  training  he  gave  evidence  of  the  possession  of  faculties 
which  might  have  developed  extraordinary  abilities.  His  teacher 
speaks  of  his  wonderful  power  of  vision  and  of  the  rapid  develop- 
ment of  memory,  especially  regarding  details.  In  fact  he  displayed 
just  that  eager  anxiety  for  knowledge  that  a  starved  person  would 
for  food ;  and  results  of  over-feeding  and  over-stimulation  proved 
similarly  disastrous,  for  his  ideas  accumulated  with  such  rapidity  as 
to  produce  a  condition  of  collapse  interrupting  his  training.  Earl 
Stanhope  became  interested  in  him  as  the  unfortunate  son  of  some 
noble  house,  but  later  convinced  that  he  was  an  impostor  withdrew 
his  protection. 

His  death  was  as  mysterious  as  his  life.  In  the  winter  of  1833  ne 
was  stabbed  in  the  park  at  Anspach,  where  he  said  he  had  met  a  man 


122  ETIOLOGY. 

by  appointment;  but  the  wound,  from  the  effect  of  which  he  died 
within  a  few  days,  was  thought  by  some  to  be  self-inflicted.  The 
views  of  those  directly  charged  with  his  education  seem  con- 
firmed in  the  autopsy,  i.  e.,  "that  the  mental  development  was  not 
hindered  by  the  deficient  growth  of  the  brain,  but  the  brain  was  re- 
tarded in  its  development  by  the  absence  of  all  mental  activity  and 
excitement." 

In  striking  contrast,  are  those  exceptional  cases  of  isolation 
through  deprivation  where  mental  development  early  begun  and  per- 
sistently pursued  is  achieved  through  the  single  avenue  of  the  sense 
of  touch,  the  most  remarkable  being  Laura  Bridgman  and  Helen 
Kellar,  both  pupils  of  the  Perkin's  Institute  for  the  Blind,  Boston, 
Massachusetts. 

Laura  Bridgman,  the  victim  of  scarlet  fever  when  only  two  years 
old,  lost  sight  and  hearing  completely,  both  taste  and  smell  being 
also  greatly  impaired.  Dr.  Howe  gives  a  graphic  account  of  con- 
tinuous training  from  her  sixth  to  her  twentieth  year,  enabling  her 
to  enjoy  simple  manual  and  household  occupations,  as  well  as  cor- 
respondence with  associates  and  friends,  pursuing  a  useful,  contented 
existence  to  quite  an  advanced  age. 

Helen  Kellar,  deprived  at  18  months,  also  by  fever,  of  sight  and 
hearing,  was  the  subject  of  solicitous  care  up  to  her  seventh  year, 
when  her  technical  training  began.  She  displayed  the  same  delight 
in  the  acquisition  of  knowledge  as  had  Kaspar  Hauser,  but  pursued 
under  more  healthful  environment  with  happier  results. 

The  sign  language  of  the  deaf  and  dumb,  was  her  first  means  of 
intercourse  with  the  outer  world.  Later  developing  a  wonderful 
talent  for  languages,  the  Braille  system  for  the  blind  became  an  open 
.sesame  to  the  literature  of  many  tongues,  French,  German,  Latin, 
and  Greek  in  turn  yielding  their  treasures  to  her  eager  search,  while 
oral  speech,  finally  achieved,  freed  her  in  large  measure  from  the  iso- 
lation so  graphically  depicted  in  her  autobiography.  Taking  with 
honors  the  Harvard  preliminary  examination  at  the  early  age  of  19, 
she  entered  Radcliffe  College  in  1899. 

The  various  data  with  which  we  have  been  occupied  have  been 
gathered  from  the  records  of  no  less  than  15,745  cases,  the  results  of 
years  of  study  and  research  of  men  engaged  in  the  work.    In  review- 


ETIOLOGY.  123 

ing,  comparing,  and  summing  up,  a  consensus  becomes  evident  re- 
garding the  production  by  each  or  any  of  the  causes  cited  of  a  mal- 
nutritive  condition  tending  so  to  prevent,  to  arrest,  or  to  retard  de- 
velopment, physical,  mental,  or  moral,  as  to  result  in  idiocy  or  im- 
becility. By  all,  the  hereditary  causes,  whether  acting  singly  or  in 
combination,  are  found  to  be  most  pronounced  and  these  again  are 
distinctly  accentuated  in  the  condition  of  mothers  during  gestation, 
and  in  the  heredities  of  imbecility  and  of  phthisis.  Furthermore  the 
influence  of  some  congenital  cause  is  frequently  traceable  in  many 
of  the  accidental  and  developmental  causes  attributed. 

Heredity  is  herein  proven  law,  as  inexorable  in  the  descending  as 
it  is  beneficent  in  the  ascending  scale ;  heredity — whether  it  be  direct 
from  parent  to  child,  collateral  as  from  other  relatives,  or  reversional 
reappearing  ever  and  anon  through  generations — which  none  may 
escape. 

Again,  a  knowledge  of  causation  and  the  assurance  that  many 
pathways  lead  to  one  condition  of  ill,  idiocy — a  condition  which  may 
be  doubled  and  quadrupled  through  inheritance — should  surely  have 
its  influence  in  inducing  the  adoption  of  means  of  prevention,  wiser 
and  more  humane  than  those  practised  by  older  nations  to  preserve 
the  integrity  of  society.  Not  by  destroying  the  life  of  the  weakling 
but  by  refusing  to  allow  him  to  perpetuate  a  maimed  existence ;  next 
by  a  simplification  of  all  life,  be  it  in  the  pursuit  of  wealth  or  learn- 
ing, of  occupation  or  amusement — a  conservation  in  lieu  of  a  dissi- 
pation of  energy;  then,  after  this  elimination  of  harmful  influences, 
such  selection  in  mating,  as  shall  insure  only  the  survival  of  the 
fittest. 


CHAPTER   V. 

diagnosis.    prognosis.    death  periods. 

Diagnosis. 

Before  entering  upon  the  close  discrimination  which  the  diagnos- 
ing of  the  different  grades  of  mental  defect  demands,  it  may  be  well 
to  mention  briefly  some  general  indications  noticeable  in  the  periods 
of  infancy,  early  childhood  and  youth ;  an  early  recognition  of  which 
might  retard  the  degeneration  that  ignorance  would  precipitate,  and 
lead  to  the  seeking  of  specialized  treatment  and  training  in  time  to 
secure  the  best  results. 

The  child  who  enters  life  through  the  portals  of  undue  suffering, 
or  who  comes  freighted  with  a  pernicious  heredity,  will  perhaps  be 
found  either  extremely  quiet  and  apathetic,  or  fretful  and  excitable ; 
the  eyes  staring  and  vacant  or  rolling  aimlessly  may  see  without  look- 
ing, or  as  in  cases  of  photophobia  be  nervously  hidden  from  view. 
The  child  is  slow  in  learning  to  sit,  to  hold  up  its  head,  to  use  its 
hands.  He  is  backward  in  noticing  objects, in  responding  to  caresses, 
and  the  mother,  to  him,  is  often  no  more  than  any  other  nurse ;  or  he 
may  be  restless,  nervous,  irritable,  crying  and  refusing  to  be  pacified. 
Similar  nervous  signs  may  be  noticed  in  slumber,  which  is  either  pro- 
longed beyond  the  usual  healthful  period,  or  is  fitful  and  broken, 
while  there  may  be  spasmodic  or  choreic  movements  of  features  and 
limbs  and  almost  always  incontinence  of  urine. 

Slavering  is  common,  due  to  the  hyperemic  conditions  of  the  sali- 
vary glands,  the  want  of  muscular  power  in  the  lower  lip  or  the 
prognathous  form  of  the  jaw  and  its  inadequate  size.  Such  babies 
do  not  take  hold  of  either  breast  or  bottle,  so  that  feeding  is  often 
extremely  difficult ;  digestion  and  assimilation  is  therefore  imper- 
fect, and  frequent  emesis,  excessive  diarrhea  or  extreme  constipa- 
tion, the  natural  result. 

The  hearing  imperfect,  speech  is  delayed  often  beyond  the  seventh 
year  and  articulation  is  apt  to  be  defective.     Lack  of  coordination 

124 


Plate  XXI. 


DIAGNOSIS.  125 

and  of  reflex  muscular  movement  is  seen  in  the  halting,  slouching 
gait.  There  may  be  quietude  amounting  sometimes  to  sullenness 
and  indifference,  or  aversion  to  companionship  and  a  general  inertia 
unnatural  to  normal  childhood ;  or  excessive  nervous  flightiness  and 
a  disposition  to  wander  aimlessly  from  one  thing  to  another,  asso- 
ciated with  meaningless  chatter  and  silly  laughter.  Both  are  indica- 
tions of  the  abnormal  ego,  or  the  secret  of  the  first  may  later  prove 
to  be  a  tendency  to  erethism — a  tendency  naturally  increasing  as 
childhood  merges  into  adolescence.  Early  childhood  may  develop 
a  backwardness,  or  a  precocity  equally  abnormal  which  either  neg- 
lect or  over-stimulation  in  overcrowded  classes  will  tend  to  increase. 
The  child  needs,  therefore,  to  be  carefully  studied,  noting  the  influ- 
ences both  of  its  heredity  and  of  its  environment,  that  much  may  be 
and  of  its  environment?  How  much  may  be  averted  by  not  forcing 
averted  by  not  forcing  mere  backwardness  into  permanent  defect. 
Peculiarities  that  may  be  noted  are:  Cranial  deviations  from  the 
normal — asymmetric,  flattened  or  seemingly  pressed  out  of  shape; 
the  head  abnormally  small — microcephalic,  or  abnormally  large — 
hydrocephalic.  The  ears  deformed,  enlarged,  twisted  or  rudimen- 
tary ;  the  lobules  frequently  defective,  adherent  or  absent ;  pinnae  and 
helices  faulty ;  tubercles  of  Darwin  often  present ;  the  ear  may  be  im- 
planted further  back  than  normal.  The  nose  rudimentary,  enlarged, 
flattened  or  the  alse  very  wide.  The  mouth  large  and  coarse,  often 
in  the  lower  grades  open  and  drooling  (sialorrhea)  ;  the  lips  either 
thick,  negroid,  frequently  sore  at  the  corners,  or  thin,  immobile  and 
inexpressive ;  the  palate  misshapen,  narrow  and  vaulted  like  an  in- 
verted V;  the  gums  swollen  and  spongy;  the  tongue  pointed  and 
fissured,  or  thickened  and  rough ;  the  teeth  decayed,  and  mastication 
being  imperfect,  the  foul  breath  is  intensified  by  poor  digestion, 
merycism  often  occurring.  The  hand  is  altogether  powerless  or 
prehension  is  feeble;  the  fingers  are  thick  and  clubbed,  the  nails 
brittle,  rough,  or  corrugated.  The  organs  of  sight  and  hearing  may 
b>e  perfect  and  yet  useless — that  is,  the  child  may  be  able  to  see  but 
not  to  look — to  hear  but  not  to  listen;  impressions  upon  the  optic 
and  auditory  nerves  are  transmitted  to  the  sensorium,  but  no  idea 
is  excited.  The  skin  shows  signs  of  degeneration,  it  may  be  coarse 
and  flabby,  the  secretions  being  of  a  peculiar  pungent  odor;  there 


126  DIAGNOSIS.      PROGNOSIS.      DEATH    PERIODS. 

is  proneness  to  eczema,  rupia  and  other  cutaneous  diseases,  the  veg- 
etable and  animal  parasites  finding  here  congenial  soil.  The  bones 
are  usually  brittle.  There  is  commonly  a  phenomenal  memory  in 
every  grade  above  the  idiot;  a  memory  for  dates  and  extraordinary 
events,  but  no  practical  or  residual  memory  for  every-day  occur- 
rences. 

In  considering  physical  characteristics  of  mental  defectives,  the 
various  ethnological  types  are  easily  recognizable :  the  dark  skin, 
curled  hair,  and  thick  negroid  lips  of  the  Ethiopian;  the  prominent 
cheek  bones,  and  deep-set  eyes  of  the  American  Indian ;  and  the 
tawny  skin,  coarse  hair  and  peculiar  Chinese  cast  of  countenance  of 
the  Mongolian.  The  cretin  who  is  sometimes  confounded  with 
this  last  named  may  be  distinguished  by  the  short  squat  figure  and 
pendulous  abdomen,  wide  mouth,  flat  nose,  etc. 

In  both  idiocy  and  imbecility,  the  sexual  desires  are  exaggerated 
in  the  various  grades  in  proportion  to  the  predominant  power  of 
the  mere  animal  over  the  psychic  forces.  In  all  grades,  the  organs 
of  reproduction  are  generally  fully  developed,  except  that  in  the 
female  the  ovaries,  not  infrequently,  are  small.  The  penis  is  almost 
invariably  unusually  large,  and  in  the  majority  of  cases  there  is  a 
very  long  prepuce.  Boys  should  be  examined  in  early  infancy  and 
circumcision  performed  from  motives  of  cleanliness  as  well  as  a  safe- 
guard against  the  formation  of  bad  habits. 

The  idiot  commonly  dwarfed  and  under-sized,  exhibits  those  signs 
of  physical  weakness  which  at  once  betray  mental  degeneration. 
Mutism  or  deafness,  where  the  cause  is  proven  not  local,  indicates 
plainly  a  cerebral  lesion  or  deficiency;  so  also  insensitiveness  to 
touch,  inhibition  to  pain,  a  lack  of  muscular  coordination  impeding 
or  preventing  locomotion,  unclean  habits,  vacant  expression,  and 
drooling  mouth,  are  all  manifest  signs  of  idiocy,  profound  or  super- 
ficial. 

The  profound  idiot,  apathetic,  can  give  no  expression  to  his 
wants  by  either  speech  or  motion ;  he  lies  simply  a  breathing  mass 
of  helplessness.  The  excitable  is  distinguished  from  him  only  by 
the  bleating  cry  and  almost  constant  imperative  movements  which 
seem  his  one  gratification — the  rolling  of  the  head  on  its  axis,  the 
swaying  of  the  body  to  and  fro,  and  the  rhythmic  movements  of  fin- 


DIAGNOSIS.  127 

gers  before  the  eyes.  Both  at  any  age  whatsoever  are  more  helpless 
than  the  ordinary  normal  infant  and  have  not  even  an  intelligent 
animal  existence. 

With  the  superficial  idiot,  whether  apathetic  or  excitable,  is 
found  a  certain  degree  of  reflex  muscular  action,  but  poor  coordina- 
tion. Speech  and  locomotion  are  possible  but  always  imperfect  and 
halting.  Mutism  is  the  rule  with  apathetics  of  this  type  who  with 
dribbling  saliva  will  blow  bubbles  from  their  lips  and  make  known 
their  wants  by  signs  and  inarticulate  cries.  The  gait  is  the  uncertain 
and  tottering  step  of  infancy,  or  not  infrequently,  the  limbs  are 
partially  or  wholly  paralyzed  and  the  extremities  cold  and  livid, 
owing  to  poor  circulation.  The  excitable  idiot  of  this  class  is  a 
very  imp  of  mischief  with  violent  temper,  wilful  and  irritable 
under  restraint.  Restless,  always  in  motion,  curious  to  a  degree, 
testing  everything  with  finger  and  tongue,  he  will  lick  furniture, 
door-knobs,  etc.,  and  even  swallow  stones,  rags,  sticks,  and  gar- 
bage of  every  description.  Speech  delayed,  is  confined  to  monosyl- 
lables, short  phrases  and  broken  sentences,  supplemented  by  gestures 
or  harsh  animal  cries.  The  gait  is  an  unsteady  shuffle,  with  dragging 
footstep  and  body  bending  forward,  especially  marked  where  there 
is  a  history  of  meningitis ;  or  excessive  excitation  of  temperament 
is  often  associated  with  a  peculiar  tip-toe  step  and  automatic  move- 
ments of  head,  hands  and  body. 

The  idio-imbecile,  hardly  a  step  in  advance  of  the  idiot,  stands  as 
his  name  denotes,  midway  between  idiot  and  imbecile,  sharing  the 
physical  characteristics  and  habits  of  the  former,  with  something 
of  the  limited  mental  capacity  of  the  lowest  grade  of  the  latter. 
Conditions  however  approximate,  change,  and  merge  so  impercep- 
tibly, that  the  experienced  eye  alone  can  recognize  and  place  him. 
The  dragging  footstep  and  lurching  gait  of  the  idiot  is  accentuated 
rather  than  diminished  in  the  awkward  clumsy  using  of  added  mus- 
cular power  which  is  yet  incoordinated.  The  skin  is  coarse,  peel- 
ing in  large  flakes,  and  poor  circulation  induces  obstinate  ulcers. 
There  is  added  speech  power  much  dissipated  in  senseless  chatter 
and  unmeaning  laughter,  while  limited  vocabulary  still  imposes  the 
use  of  signs.  There  is  a  kind  of  grotesque  travesty  of  humanity  in 
this  type;  indeed  it  is  only  through  imitation — a  certain  apishness 


128  DIAGNOSIS.      PROGNOSIS.      DEATH    PERIODS. 

— that  they  are  brought  to  render  an  automatic,  rather  than  an  in- 
telligent service  in  the  humblest  offices  of  household  or  nursery. 
They  are  apt  to  be  irritable,  excessive  silliness  changing  suddenly 
to  temper  quite  as  unreasonable. 

Very  near  akin  to  him  is  the  imbecile  of  low-grade.  The  stig- 
mata are  marked,  and  his  speech  always  betrays  him.  There  may 
be  a  redundancy  of  words — often  a  perpetual  chatter — but  always 
with  defective  articulation.  What  mothers  are  apt  to  hope  is  mere 
backwardness  soon  proves  utter  incapacity;  unable  ever  to  learn 
to  read  or  write,  or  to  accomplish  more  than  the  simplest  and  most 
ordinary  occupations  of  life,  "  this  brother  to  the  ox,"  will  never 
be  more  than  a  hewer  of  wood  and  drawer  of  water. 

The  imbecile  of  middle-grade  in  the  ascending  scale  of  mental 
defect  is  the  first  to  approximate  in  the  slightest  degree  the  normal, 
and  to  evince  an  intelligence  more  human  and  less  merely  animal. 
The  temperament  compared  with  that  of  the  low  and  high-grades, 
is  equable,  though  leaning  always  towards  suggestion ;  and  this  sus- 
ceptibility to  influence  is  perceptible  also  in  the  general  bearing 
which  partakes  of  the  character  of  environment  and  association. 
Defects  of  vision  and  of  hearing  are  frequent,  and  asymmetries 
and  left-handedness  are  common.  This  is  the  dullard  of  the  schools, 
with  power  of  attention  feeble,  and  of  concentration — except  under 
strong  incentive — nil.  Easily  fatigued  and  confused,  abstract  and 
artificial  signs  hold  his  attention  for  short  periods  only.  Independ- 
ent study  is  for  him,  therefore,  impossible  and  he  is  absolutely 
unable  to  advance  further  than  the  simplest  primary  work  with 
books.  Yet  he  is  easily  interested  in  conversation,  in  object  lessons 
and  nature  studies,  and  in  industrial  and  manual  work  his  energies 
can  be  enlisted  in  many  directions. 

The  high-grade  imbecile  may  be  one  of  those  known  as  odd, 
peculiar  and  erratic.  Without  revealing  actual  definite  stigmata, 
the  whole  physique  may  so  lend  itself  to  or  be  warped  by  mental 
idiosyncrasies,  as  to  give  a  general  impression  to  the  casual  ob- 
server of  something  different  from  the  ordinary.  Such  often  are 
the  idiots  savants  developing  talent  in  one  direction  or  dominated  by 
one  idea,  showing  a  mental  asymmetry  or  one-sidedness.  Again 
he  may  be  physically  normal,  and,  to  all  appearances,  mentally  also, 


DIAGNOSIS.  129 

but  there  is  perhaps  a  history  of  unusual  precocity  in  infancy  and 
early  childhood.  He  has  been  the  wide-awake  baby,  doing  and  saying 
remarkable  things  or  later  the  mathematical  prodigy  of  the  class ; 
he  has  a  phenomenal  memory  for  dates  and  numbers  with  but  little 
recollection  of  daily  events.  He  collects  with  avidity  isolated  facts 
which  he  can  neither  classify  nor  apply.  The  opposite  of  the  im- 
becile of  middle-grade,  books  and  abstract  studies  are  devoured,  but 
not  assimilated  serve  only  to  produce  a  mental  indigestion.  Without 
the  healthful  reaction,  which  his  more  fortunate  brother  has  found  in 
manual  training,  he  turns  out  a  ne'er-do-well,  crowded  out  or  pushed 
to  the  wall  in  the  struggle  of  life.  These  however  are  extremes ;  the 
average  imbecile  of  this  grade  shows  but  slight  deviation  from  the 
normal;  is  in  fact  hardly  to  be  distinguished  from  the  backward 
child,  with  whom  he  may  or  may  not  keep  pace  in  the  school  cur- 
riculum, up  to  the  point  where,  his  mental  limit  being  reached,  there 
is  for  him  no  further  advance. 

In  the  moral  imbecile  the  degeneration  of  the  psychic  forces  is  the 
peculiar  and  distinctive  feature,  the  perversion  or  the  complete  ab- 
sence of  the  moral  sense  being  revealed  according  to  the  character 
of  the  grade  in  which  it  appears.  In  the  low-grade  we  find  the 
cruel  or  bestial  type — a  sensual  delighting  in  evil  propensities.  In 
the  middle-grade,  the  absence  of  altruism  and  constant  infringement 
of  the  rights  of  others  appears,  simply  from  the  love  of  mischief  or 
the  excitement  of  accomplishment.  In  the  high-grade,  there  is  a 
refinement  of  evil ;  the  mental  powers  subordinated  wholly  to  a  per- 
verted moral  sense,  exhibit  often  a  craftiness  and  skill  truly  satanic, 
while  the  not  infrequent  association  of  great  physical  beauty  and 
bodily  vigor  together  with  the  entire  absence  of  physical  stigmata, 
renders  the  recognition  of  this  type  except  by  experts  impossible; 
they  would  literally  deceive,  often,  the  very  elect. 

The  backward  or  feebly-gifted  child  who  can  never  keep  up  with 
his  fellows,  who  is  dreamy,  unsocial,  stolid  often  to  stupidity,  or  who, 
nervous  and  excitable,  wanders  from  one  thing  to  another  until  some 
congenial  occupation  attracts  and  chains  attention,  appears  more 
abnormal  than  do  many  imbeciles  of  high  grade.  So  close  are  the 
lines  in  fact,  that  a  diagnosis  is  often  extremely  difficult  and  even 
the  alienist  must  allow  time  and  treatment  to  work  out  for  him  the 


130  DIAGNOSIS.       PROGNOSIS.      DEATH    PERIODS. 

problem.  Due  often  to  the  same  causes,  congenital  or  accidental, 
general  characteristics  and  habits  may  be  identical  with  those  of  the 
high-grade  imbecile,  with  the  difference  that  the  trouble  may  not  be 
so  deep-seated.  The  feebleness  may  be  diffused  without  being  con- 
centrated or  localized,  the  whole  physical  constitution  being  so  de- 
cidedly below  tone  as  to  hinder  and  even  over-power  for  the  time 
mental  activities,  without  necessarily  causing  cerebral  lesion  or  defi- 
ciency, which  however,  accident  or  undue  pressure  might  at  any  time 
precipitate. 

Prognosis. 

The  mistaken  idea  of  seeking  a  cure  for  mental  defect  doubtless 
has  its  root  in  a  misapprehension  of  terms  and  in  confounding  idiocy 
with  insanity.  In  the  latter  there  may  be  found  cure  as  for  any 
other  disease;  but  idiocy  is  not  disease,  it  is  defect,  and  one  might 
as  reasonably  talk  of  restoring  limbs  to  one  born  without  them  as 
of  curing  a  defective  brain.  To  replace  what  has  never  been  placed 
is  impossible.  No,  there  is  no  cure,  nevertheless  much  may  be 
accomplished  in  the  way  of  amelioration  and  improvement.  In  the 
awaking  of  dormant  faculties,  and  in  the  development  and  fostering 
of  latent  powers,  deterioration  may  be  arrested  and  retrogression 
prevented.  Thus  the  idiot,  unless  of  the  extreme  type  of  helpless 
infancy,  may  be  brought  to  acquire  cleanly  habits,  and  to  practice 
such  offices  of  self-help  as  to  materially  lessen  the  burden  of  his 
care,  while  the  idio-imbecile  may  be  taught  all  this,  and  further  to 
aid  in  the  care  of  the  absolutely  helpless.  The  low-grade  imbecile 
may  be  guided  in  the  simple  occupations  of  farm  or  household,  which 
with  his  knitting  and  weaving  may  contribute  to  his  maintenance. 
The  middle-grade,  a  step  further,  gains  a  certain  proficiency  in  ordi- 
nary hand-crafts. 

The  high-grade  imbecile,  who  is  almost  normal,  while  closely 
approximating  the  backward  or  feeble-gifted,  yet  differs  in  that  he 
suffers  from  absolute  defect,  which  may,  in  a  measure,  be  supple- 
mented by  strengthening  those  things  that  remain  to  him,  but  which 
can  never  be  wholly  supplied  or  restored.  His  defect  is  not  only 
limited  mental  capacity,  but  the  psychic  forces  are  wanting,  feeble, 
or  lacking  in  quality,  just  as  we  have  noted  are  the  physical  powers 
in  the  idiot.     Judgment  and  will,  power  of  discrimination,  and  even 


DEATH    PERIODS.  I3I 

a  certain  amount  of  discretion  there  may  be  ;  but  even  when  strength- 
ened and  built  up,  at  the  best  these  are  only  such  as  a  well  grown 
boy  or  girl  will  exhibit;  vacillation,  indolence,  or  an  acute  suscep- 
tibility to  suggestion,  may  be  at  any  time  his  undoing  for,  unstable 
as  water,  he  will  not  excel  unless  sustained  and  protected  by  a  will 
stronger  than  his  own.  A  child  the  feeble-minded  must  ever  be  by 
comparison  and  in  competition  with  normal  people,  but  even  a  child 
may  be  brought  to  fill  acceptably  a  life  of  service  in  his  simple  sphere, 
however  limited ;  and  in  that,  by  constant  exercise,  feeble  power  may 
be  raised  to  its  maximum  point  and  kept  there  possibly  for  some 
years,  before  the  deterioration  which  inevitably  comes  at  the  close 
of  the  life  period ;  this  for  defective  children  is  generally  mercifully 
brief. 

The  moral  imbecile  of  any  grade  must  find  his  only  safety  in 
congenial  occupation  in  sequestration,  under  constant  unremitting 
supervision. 

The  feebly-gifted  or  backward  child  has  not  crossed  the  border 
line,  and  by  simply  making  haste  slowly  and  avoiding  risk  of  over- 
stimulation may  finally  reach  the  goal  open  to  all  normal  minds, 
though  by  a  more  circuitous  route.  He  is  not  a  mental  defective, 
but  a  mental  invalid,  so  to  speak,  possessed  of  all  his  powers;  and 
has  the  same  chance  of  attaining  mental  vigor  that  any  sickly  child 
has  of  being  brought  to  full  health  through  proper  treatment. 

Death  Periods. 

The  frequent  inquiry  made  as  to  the  probable  life  limit  of  mental 
defectives,  has  induced  me  to  make  a  careful  study  of  death  periods 
and  causes  in  some  625  cases.  The  result  as  presented  in  the  accom- 
panying table  shows  the  largest  number  of  deaths  occurring  between 
the  tenth  and  twentieth  years ;  but  comparatively  few  pass  the  twenty- 
fifth  year,  and  exceptional  cases  appear  from  thirty  to  forty  years. 


132 


DIAGNOSIS.      PROGNOSIS.      DEATH    PERIODS. 


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Plate  XXI 


Case  G. 
MORAL    IMBECILES  — LOW-GRADE. 


CHAPTER   VI. 
training  and  treatment. 

Training. 

In  comparing  the  training  of  feeble  minds  with  the  training  of 
normal,  several  points  must  be  considered.  In  dealing  with  the  lower 
grades  who,  as  we  have  noted,  neither  see  nor  hear  voluntarily  and  are 
therefore  incapable  of  observation,  many  things  must  be  persistently 
taught  that  normal  children  acquire  or  glean  intuitively.  The  proper 
mastication  of  food,  the  use  of  the  spoon,  fork  and  knife,  the  dressing 
and  care  of  the  body,  the  standing  and  walking  unsupported ;  indeed, 
from  the  very  simplest  matters  of  self-help  up  to  the  attainment  of 
some  regular  employment,  step  by  step,  must  there  be  daily  persistent 
showing  or  leading  until  the  limit  of  capacity  be  reached.  Work  in 
small  classes  insures  best  results,  escaping  monotony,  and  giving 
requisite  emulation.  The  awakening  of  torpid  or  dulled  sense  percep- 
tion must  necessarily  be  through  means  sharply  accentuated  and  fre- 
quently repeated.  The  lessons  proceeding  very  gradually  from  sim- 
ple to  complex  must  be  in  no  sense  abstract,  the  subjective  reproduc- 
tion of  the  pupil  following  closely  the  objective  illustration  of  the 
teacher.  As  the  average  period  of  receptivity  extends  only  from  the 
seventh  to  the  sixteenth  year,  and  as  four  times  the  period  of  normal 
practice  is  required  to  insure  independent  work,  it  is  imperative  that 
the  instruction  from  the  beginning  be  adapted  to  the  child  and  to  his 
peculiar  status.  It  is  most  important,  therefore,  that  the  work  be 
directed  by  an  expert,  for  either  delay  or  overpressure  will  defeat 
the  aim  and  bring  inevitable  deterioration.  The  following  outline 
is  formulated  and  based  upon  data  gathered  from  the  experiments 
and  experience  of  the  first  century  of  work  with  mental  defectives. 

Outline   of   Physiologic   Education   of   Mental   Defectives. 

For  lower  forms  improvement ;  by  means  of : 
(a)  The  testing  of  the  various  sense-organs,  so  that  defects  may 
be  remedied  by  surgical  or  medical  treatment. 

133 


134  TRAINING   AND   TREATMENT. 

(&)  The  gradual  awakening  of  the  senses  by  the  presentation  of 
objects  that  attract,  of  exercises  that  stimulate  the  attention  and 
encourage  imitation ;  achieving  limited  capacity,  self-help,  and  cleanly 
living. 

(c)  The  exercise  of  the  awakened  senses  in  simple  occupations, 
preparing  for  menial  employment  under  direction. 

For  higher  grades  development: 

(a)  Of  the  emotions,  through  exercise  in  acts  moral  and  ethical; 
achieving  habits. 

(b)  Of  the  body,  through  exercise  in  military,  gymnastic,  and 
athletic  activities ;  the  training  of  the  hand  in  the  industrial  and 
manual  arts,  the  chief  agent  in  promoting  mental  activity. 

(c)  Of  the  mind,  in  power  of  prehension  and  apprehension,  judg- 
ment and  will  alternately  sustained  and  independent;  achieving 
selfhood. 

Aids. 
Environment.  Amusement. 

Association.  Discipline. 

The  training  of  the  feeble-minded,  a  philanthropic  movement 
directed  first  toward  the  idiot,  soon  found  a  limit  in  dealing  with  a 
subject  not  trainable  and  but  slightly,  if  at  all,  improvable.  Thence, 
diverging  and  broadening  as  idiocy  became  better  understood  and 
imbecility  in  its  various  phases  more  clearly  recognized,  it  found 
its  true  province  in  strengthening  and  encouraging  feeble  in- 
tellects, arousing  and  stimulating  indolent  and  weak  wills,  and  in 
training  and  directing  into  healthful  channels  the  abnormal  energy 
of  those  destitute  of  the  moral  sense.  How  wide  is  this  divergence 
can  now  readily  be  seen,  as  also  how  impractical  it  is  to  associate  two 
classes  of  work  that  must  be  conducted  on  different  lines,  and  which 
in  reality  are  further  apart  than  is  the  training  of  imbecile  and  of 
normal  children. 

For  the  Idiot,  unimprovable,  nothing  is  needed  beyond  the  asylum, 
giving  that  care  and  attention  found  in  every  well-regulated  nursery 
of  delicate  children,  the  sine  qua  non  being  regular  hours,  simple 
nourishing  food,  frequent  baths,  and  tender  mothering.  As  num- 
bers can  be  cared  for  here  more  efficiently  and  with  greater  ease 


TRAINING   AND   TREATMENT.  I  35 

than  can  one  in  the  ordinary  family,  and  as  the  child  very  often  does 
not  recognize  the  hand  that  ministers  to  his  physical  wants,  the 
mother  herself  is  soon  forced  to  admit  that  the  asylum  is  best,  not 
only  for  the  good  of  the  child,  but  also  for  the  welfare  of  the  home. 

As  many  of  these  unfortunates  are  paralyzed,  blind,  or  lame,  it  is 
desirable  that  the  dormitories,  well  ventilated,  be  on  the  same  floor 
with  the  living  rooms,  and  of  easy  access  to  bathrooms  and  play- 
grounds. Covered  and  carefully  guarded  porches  should  afford  the 
much-needed  fresh  air  and  outdoor  exercise  in  all  weathers.  These, 
with  cheerful,  sunny  play-rooms,  provided  with  simple  toys  and  fur- 
nished with  bright  decorations  varying  with  the  season,  will  contribute 
the  maximum  of  pleasure  for  this  life  of  perpetual  infancy.  Low 
vitality,  general  poverty  of  the  whole  physical  make-up,  the  prevalence 
of  phthisis,  epilepsy,  and  kindred  diseases,  require  the  daily  inspec- 
tion of  a  physician,  while  the  comfort  and  well-being  of  the  entire 
community  is  insured  by  a  capable  and  sympathetic  house-mother. 

The  character  of  attendants  is  of  the  first  importance,  as  these 
are  they  who  live  with  the  children ;  it  should  combine  that  firmness, 
tenderness,  and  balance  that  constitutes  an  even  temperament,  capa- 
ble of  recognizing  and  meeting  an  occasion  without  loss  of  self- 
control.  The  duties  include  not  only  the  care  of  the  idiots,  both 
unimprovable  and  improvable,  but  the  training  and  direction  of  idio- 
imbeciles  as  aids ;  and  this  dealing  with  natures  often  wholly  animal 
requires  a  certain  refinement  and  dignity  of  character,  at  least  an 
entire  absence  of  coarseness,  while  a  knowledge  of  the  simpler  man- 
ual arts,  and,  if  possible,  of  drawing  and  of  music,  will  do  much  to 
soften  and  brighten  these  darkened  natures.  As  these  qualities  are 
valuable,  as  well  as  rare,  the  remuneration  should  be  in  proportion ; 
certainly  sufficient  to  insure  permanency  and  to  compensate  for  such 
isolation.  A  life  of  constant  wear  and  tear  demands  also  regular 
periods  of  rest,  and  the  corps,  therefore,  should  be  sufficiently  large 
to  give  relief  hours  daily,  as  well  as  occasional  vacations. 

Improvement. — For  the  Idiot,  improvable,  success,  even  to  the 
limited  degree  possible,  is  best  assured  in  congregate  numbers; 
as  for  the  charlatans,  who  profess  to  train  a  single  pupil  and  in  a 
few  years  send  him  out  prepared  to  take  a  high-school  or  a  college 
course,  they  not  only  deceive  those  from  whom  they  may  gather  a 


I36  TRAINING   AND   TREATMENT. 

few  thousands,  but  they  impede  the  progress  of  the  work  by  such 
misrepresentation.  One  of  these  averred  to  me  that  she  had  so 
educated  a  microcephalic  idiot  that  he  became,  later,  a  professor  in 
a  university.  That  there  was  absolutely  no  truth  in  her  statement, 
there  can  be  no  doubt;  one  cannot  do  the  impossible.  Relays  of 
teachers  of  experience  and  versatility  might,  in  time,  through  exer- 
tions almost  superhuman,  raise  a  superficial  idiot  for  a  brief  period 
to  the  level  of  an  idio-imbecile,  but  this  could  be  attained  only  by 
the  expenditure  of  much  time  and  money,  and  by  sapping  the  vital- 
ity of  the  teacher ;  and  all  this  with  an  absolute  certainty  of  eventual 
reversion  to  original  type,  so  that,  emphatically,  it  would  not  pay. 
No,  "  an  infant  crying  in  the  night  and  with  no  language  but  a  cry," 
with  most  imperfect  speech,  if  any,  an  idiot  must  ever  be ;  but  an 
infant  with  cleanly  habits,  he  may  possibly  be  brought  to  be.  He 
may  be  taught  to  say  "  papa  "  and  "  mama,"  to  repeat  his  nurse's 
name,  or  perhaps  that  of  a  companion ;  to  utter  a  few  disconnected 
words,  or  at  best  a  broken  sentence,  rarely  of  more  than  three 
words,  never  using  the  pronouns  correctly;  and  thus,  through  long 
and  persistent  effort,  he  may  be  enabled  to  make  known  his  wants, 
but  this  is  all. 

The  axiom,  proven  in  kindergarten  and  so  often  quoted  of  large 
families,  that  "  children  do  much  of  the  bringing  up  of  one  another," 
is  true  even  for  these  morsels  of  humanity.  Here,  efforts  to  make 
sense  impressions,  to  arouse  attention,  or  to  excite  to  free  play  are 
more  successful  with  a  number  than  with  one;  then,  too,  children 
follow  naturally  a  leader  of  their  own  kind,  become  less  shy  and 
more  eager,  are  more  ready  to  imitate  one  of  their  fellows ;  and  imi- 
tation is  a  most  important  agent.  In  a  series  of  sense-impressions, 
beginning  with  sight,  one  seeks  to  engage  the  wandering  gaze  or  to  at- 
tract the  apathetic,  with  contrasts  of  color  in  combination  with  alter- 
nate motion  and  repose;  such  as  by  swinging  balls  of  bright  and 
neutral  tints,  alternating  and  well  spaced,  suspended  from  a  bar,  or 
by  laying  colored  blocks  on  the  table.  After  months  or  even  years, 
the  child  may  learn  to  match  colors  and  blocks,  to  use  peg-boards, 
to  string  beads,  to  lace  cards,  and  even  to  help  to  dress  a  manikin. 
Nerveless  fingers  may  be  induced  to  clasp  or  grasp  through  the 
necessity  of  holding  fast  during  swinging  exercises  or  by  digging 


Plate  XXIII. 


£*■  ~<4m 

M»  jH 

fiflja 

'      JF^ 

TRAINING   AND   TREATMENT.  I  37 

in  the  sand.  Hands  thus  strengthened  may  next  be  encouraged  to 
hold  a  spoon  or  a  cup,  to  lace  a  shoe,  to  tie  and  button  clothing. 
Inertia  may  be  overcome  and  some  slight  independence  of  movement 
gained  by  exercises  in  reaching  for  and  running  after  balls,  or  ani- 
mals made  of  rubber,  celluloid,  or  wool.  Bags  filled  with  corn  or 
beans  and  tossed  over  sticks  or  through  a  hole,  or  better  into  the 
mouth  or  eyes  of  a  grotesque  figure,  will  also  tend  to  strengthen 
feeble  muscles,  which  should  be  further  toned  up  by  daily  baths, 
electricity,  and  massage.  In  this  play,  as  in  all  training,  does  Froe- 
bel's  motto  hold — the  teacher  must  "  live  with  the  children."  The 
idiot  never  does  any  of  these  things  voluntarily,  nor  does  he  play 
as  do  normal  children;  but,  led  through  these  or  similar  awakening 
exercises,  he  may  attain  to  self-help  in  matters  of  cleanly  living,  and 
if,  eventually,  he  learn  to  feed,  wash,  and  dress  himself,  the  effort 
at  training  has  been  a  success,  rendering  the  child  in  that  respect 
independent,  and  so  far  simplifying  his  care  at  home ;  or  with  con- 
gregate numbers  in  asylums,  reducing  somewhat  the  number  of 
attendants  and  consequent  expense,  and  greatly  relieving  the  bur- 
den upon  those  in  charge. 

The  Idio-Imbecile,  but  one  remove  from  his  weaker  brother,  to 
whose  wants  he  may  be  trained  to  minister,  finds  here  his  fitting 
place,  and  the  domestic  service  of  these  asylums  may  be  largely 
drawn  from  this  class,  as  also  from  that  of  the  low-grade  imbecile. 
Working  as  an  aid,  never  alone,  always  under  direction,  he  finds 
in  a  monotonous  round  of  the  simplest  daily  avocations  his  life 
happiness,  his  only  safety  from  lapsing  into  idiocy,  and  therefore  his 
true  home. 

With  little  or  no  added  power  of  speech,  he  is  yet  capable  to  a 
greater  degree  than  is  the  idiot,  of  sense  awakening.  As  the  power 
of  attention  and  selection  grows,  the  numberless  simple  occupations 
of  the  kindergarten  may  be  given  to  build  up  habit  and  to  insure 
power  by  means  of  reproduction ;  such  as  the  laying  of  paper  strips 
and  disks,  making  designs  or  pictures,  building  with  blocks,  weaving 
with  wooden  slats,  sewing  cards,  etc.,  each  occupation  merging  into 
the  other,  leaving  a  little  and  adding  a  little,  until  whole  color  and 
number  schemes  be  worked  out,  and  sight  and  attention  are  arrested, 
and  selection  and  enumeration,  and  hand  and  finger  movements  are 


I38  TRAINING  AND   TREATMENT. 

in  a  measure  coordinated.     The  result  is  not  only  capacity  for  self- 
help,  but  for  quite  efficient  service  in  the  care  of  the  helpless. 

The  relief  to  the  home  and  the  actual  benefit  to  society  in  this 
housing  and  care  of  the  idiot  and  idio-imbecile  can  never  be  fully 
estimated.  It  is  reckoned,  however,  in  a  general  way,  that  for  every 
defective  of  this  class  sequestrated,  the  energies  of  two  if  not  four 
normal  persons  are  returned  to  society. 

Development. — In  the  consideration  and  observation  of  trainable 
mental  defectives — imbeciles — it  is  difficult  for  the  uninitiated  to 
understand  that  the  term,  high,  middle  or  low,  is  not  associated 
with  promotion  and  advancement  as  in  schools  for  normal  children. 
On  the  contrary,  it  signifies  the  quality  and  status  of  the  individual, 
his  limitations,  his  possibilities,  and  consequently  determines  almost 
unfailingly  his  life-work,  and  indicates  the  training  for  it;  not  by 
any  hard-and-fast  lines,  but  by  a  general  mapping  out  of  means 
which  experience  has  proved  will  best  insure  his  development,  be- 
cause best  suited  to  his  needs.  Every  latitude  is  allowed,  and  as  the 
comfort  of  both  the  teacher  and  the  entire  class  depends  upon  each 
"  going  to  his  own  place,"  there  is  easy  and  natural  transference 
according  to  the  necessity  indicated  by  either  progress  or  retrogres- 
sion ;  but  as  the  varied  occupations  in  each  grade  give  ample  scope 
for  the  indulgence  of  individual  proclivity  in  the  means  of  develop- 
ment, it  is  found  that  the  original  diagnosis,  based  upon  experience, 
rarely  errs. 

This  diagnosis  has  noted  the  stigmata,  the  positive  defects  present 
or  those  that  may  be  expected  as  revealed  by  inquiry  into  cause — con- 
genital or  accidental — the  family  history,  atavistic  tendencies,  pecu- 
liarities, idiosyncrasies,  the  general  health,  desires,  needs,  habits,  etc. 
From  these  data  an  opinion  is  derived  which  either  assigns  the  child 
to  custodial  or  asylum  care,  or  deciding  for  him  the  possibility  of 
general  training,  designates  that  grade  in  which  he  shall  be  trained. 
At  this  point  preparative  work  begins,  and  as  upon  physical  efficiency 
depends  mental  potentiality,  just  so  closely  allied  must  be  treatment 
and  training — the  work  of  the  physician  not  only  preceding,  but 
intimately  associated  with  that  of  the  teacher;  the  work  of  the 
teacher  following  closely  and  relying  upon  the  indications  given  by 
the  physician. 


TRAINING   AND   TREATMENT.  I  39 

As  the  training  is  to  be  physiologic,  every  sense  avenue  is  to  be 
interrogated,  tested,  brought  to  the  best  working  level  and  kept 
there.  One  may  expect  to  encounter  extreme  nervous  irritability, 
or  stupor  and  dullness  affecting  all  the  senses,  or  else  actual  defect 
of  one  of  the  sense-organs  demanding  surgical  or  medical  treat- 
ment. Either  of  the  first  two  calls  for  untiring  patience  and  ori- 
ginality on  the  part  of  the  teacher  in  devising  and  adapting  meth- 
ods, together  with  the  constant  aid  of  the  physician  noting  cause 
and  effect,  lest  complications  unlooked  for  arise.  The  correction  of 
any  one  defect  may  often  simplify  an  exaggerated  ill.  Apparent 
stupidity  or  inattention  may  prove  to  be  due  to  deafness  that  has 
been  unsuspected,  and  that  disappears  when  some  perhaps  trifling 
cause  is  removed.  So,  also,  defect  of  taste  may  be  due  to  catarrh; 
or  the  removal  of  adenoid  growths  may  aid  imperfect  speech  and 
prepare  the  way  for  drilling  in  articulate  sounds.  Sullen  obstinacy 
or  indifference  may  be  only  the  natural  despondency  arising  from 
defective  vision,  and  the  services  of  the  ophthalmologist  open  a  new 
world  to  the  child,  and  reveal  him  in  a  new  light  to  his  own  world. 
I  know  one  who  changed  from  the  morose  to  the  lively  in  a  ver^ 
short  space  after  seeing  life  through  other  spectacles ;  and  his  after- 
skill  with  the  pencil,  and  love  of  detail  in  pastel  was  a  delight  to  him- 
self, to  his  teachers,  and  to  his  comrades;  and  this  is  only  one  of 
many  similar  cases  that  could  be  cited. 

Inertia,  that  appears  to  resent  movement,  is  not  necessarily  stub- 
bornness or  indolence  but  may  be  due  to  timidity,  a  feeling  unex- 
pressed but  nevertheless  intuitive,  of  inability  from  lack  of  muscu- 
lar coordination  and  a  sensitiveness  in  revealing  consequent  awk- 
wardness. Given  an  incentive  that  interests,  and  that  diverts  and 
absorbs  attention — such  as  the  military  and  calisthenic  drills,  move- 
ment plays,  or  concerted  action  of  numbers  in  blackboard  drawing — 
shyness  and  morbidness  disappear,  and  with  growing  confidence 
come  the  beginnings  of  self-poise,  a  good  foundation  for  after- 
training.  Again,  the  tactile  sense  may,  to  the  inexperienced,  seem 
unimportant ;  its  absence  however  amounting  often  to  entire  hebe- 
tude to  pain  is  a  marked  characteristic  of  the  mental  defective. 
When  we  contrast  the  obtuseness  of  touch  noticeable  in  imbeciles 
with  that  sensitiveness  that  finds  its  highest  expression  in  the  arts, 


I4O  TRAINING   AND   TREATMENT. 

and  remember  what  an  avenue  it  is  to  the  deaf-mute — Pereire  actu- 
ally causing  his  pupils  to  hear  through  the  skin — we  are  prepared 
to  exclaim  with  Bufron :   "  How  wonderfully  it  is  proven  how  much 
the  senses  are  alike  at  the  bottom,  and  to  what  point  they  may  sup- 
ply one  another,"  and  to  recognize  the  value  of  this  agent  in  stimu- 
lating mental  processes  and  the  immense  necessity  for  its  awaken- 
ing.    In  this,  as  in  all  the  work  of  sense  preparation,  the  kinder- 
garten methods  are  invaluable,  and  Froebel,  with  his  "  Come  let  us 
live  with  our  children,"  is  even  more  the  friend  of  the  abnormal 
than  of  the  normal  child.     All  the  measures  previously  described 
as  suitable  for  the  idiot  are  here  elaborated  and  adapted  to  a  higher 
order  of  intelligence,  and  should  have  practical  illustration  in  the 
occupations  that  form  the  initial  of  manual  training,  associated  with 
all  the  moral  and  ethical  ideas  of  good  fellowship  in  a  community 
of  labor ;  these  should  be  further  emphasized  in  the  songs  and  games 
that,  by  the  very  power  of  rhythm,  induce  coordination  of  movement. 
Herein  lies  the  strongest  plea  for  early  recognition  and  proper  plac- 
ing before  the  child  is  too  large  for  the  kindergarten,  so  that  he 
may  not  be  deprived  of  this  preparation  for  development  and  train- 
ing; for  size  must  necessarily  exclude  from  the  games  of  childhood, 
although  we  do  say  that  "  with  us  age  does  not  count."     And  just 
here  is  a  seeming  paradox;  for  the  mental  defective  presents  three 
ages  at  the  one  time :    the  natural  or  the  actual  age,  which  dates 
from  birth;    the  psychologic,  which  is  the  retarded  age;    and  the 
physiologic,  which  is  generally  advanced.     For  example,  I  have  un- 
der my  care  a  boy  aged  twenty-eight  years ;  in  stature  and  mental 
development  he  is  a  child  of  five;    with  the  wrinkled  visage,  the 
habits,  and  the  bodily  enfeeblement  of  a  man  of  sixty.     The  need 
for  specialists  to  handle  such  complexity  is,  therefore,  self-evident, 
as  mistakes  mean  danger  in  many  directions.     The  period  of  in- 
fancy with  a  defective  child — if  the  case  be  congenital — extends  not 
only  through  three,  but  often  through  seven  years,  so  that  the  period 
when  a  normal  child  would  be  leaving  the  kindergarten,  or  perhaps 
a  little  later,  the  defective  would  be  just  ready  to  enter  it.     Expe- 
rience has  so  well  proved  this,  as  to  lead  to  a  consensus  among  those 
engaged  in  the  work,  that  training  at  an  earlier  period  than  the 
seventh  year  is  not  only  undesirable,  but  likely  to  prove  most  disas- 


Plate  XXIV. 


^^■ML 


Case  F.  Case  G. 

MORAL  IMBECILES  — MIDDLE-GRADE. 


TRAINING   AND   TREATMENT.  I4I 

trous.  This  prolonged  infancy  should  be  rather  a  chrysalis  stage, 
in  which  the  ill-nourished  physical  being  is  fed  and  strengthened  by 
repose,  and  carefully  shielded  from  all  incitements  to  precociousness 
or  any  advance  beyond  the  natural  impulses  that  Froebel  suggests 
in  "Mutter  und  Kinder,"  and  that  a  wise  mother  comprehends  in- 
tuitively; anything  further  may  provoke  an  outbreak  of  insanity  or 
a  relapse  into  profound  idiocy. 

Just  as  in  these  cases  the  period  of  infancy  is  prolonged,  so  does 
the  limit  of  receptivity  come  proportionately  early,  generally  coin- 
cident with  the  close  of  the  adolescent  period  and  rarely  extending 
beyond  the  sixteenth  year. 

Now,  as  it  takes  a  mental  defective  twice  or  three  times  as  long 
as  it  does  a  normal  child  to  learn  anything,  success  must  depend 
upon  environment  and  methods  in  order  that,  without  undue  strain 
or  pressure,  the  most  can  be  made  of  this  limited  period.  Hence 
the  importance  of  a  correct  diagnosis  at  the  beginning  and  of  the 
preparation  that  assigns  the  child  almost  unerringly  to  the  grade 
that  will  prepare  him  for  the  one  purpose  in  life  possible  to  him, 
so  that,  without  loss,  each  may  go  to  his  own  place. 

The  motto  of  the  schools,  "  We  learn  by  doing ;  the  working 
hand  makes  strong  the  working  brain,"  shows  manual  training  to 
be  the  basis  of  the  scheme  of  development  for  all,  but  modified  to 
suit  the  intelligence  in  each  grade.  Thus  classified,  various  occupa- 
tions are  arranged  and  presented  with  the  double  purpose  of  secur- 
ing all  round  development  and  of  giving  at  the  same  time  oppor- 
tunity for  choice  according  to  individual  bent,  the  child  being  per- 
mitted gradually  to  devote  himself  more  exclusively  to  that  in  which 
he  shows  a  tendency  to  excel,  and  to  gain  a  certain  automatic  ease 
in  what  shall  prove  the  initial  of  a  life  employment. 

The  faculty  of  speech,  which  we  have  noted  as  partially  or 
altogether  lacking  in  the  idiot  and  idio-imbecile,  is  found  in  pro- 
portional degree,  more  or  less  imperfect,  in  all  grades  of  im- 
becility. Due  frequently  to  defect  or  disease  of  speech-centers,  there 
may  be  other  local  causes  that  the  physician,  the  surgeon,  or  the 
dentist  can  remove  or  ameliorate.  Nevertheless,  even  with  this  as- 
sistance, there  yet  remains  the  force  of  habit  which  persistent  daily 
practice  under  special  training  alone  can  counteract. 


142  TRAINING   AND   TREATMENT. 

Mutism  or  semi-mutism  may  be  due  to  a  torpidity  which  is  both 
mental  and  physical,  accentuated  sometimes  in  the  region  of  the 
aural  and  nasal  passages  by  defect  or  disease  so  slight  as  to  be 
unsuspected  or  overlooked,  as  is  too  often  the  case.  Children  so 
affected  either  gain  no  impression  from  environment  through  ordi- 
nary means,  or  the  sensation  feebly  received  is  so  feebly  transmitted 
as  to  fail  in  resultant  concepts  or  ideas.  Speech  consequently  is 
impossible ;  they  cannot  reproduce  an  idea  that  has  never  been  pro- 
duced, and  impaired  audition  forbids  the  senseless  chatter  of  mere 
repetition,  observable  in  many  as  powerless  as  they  to  originate.  To 
such  children  the  games  and  songs  of  the  kindergarten  give  a  needed 
stimulus,  not  only  providing  a  subject,  but  giving  the  aid  of  imita- 
tion and  repetition;  and  that  through  an  inspiring  medium,  for  it 
is  often  easier  to  sing  a  word  than  to  speak  it.  Then,  too,  the  imi- 
tation of  animal  cries  or  of  other  familiar  sounds  brings  in  all  the 
vowel,  and  many  of  the  more  difficult  consonant  sounds.  Many 
children  who,  for  the  same  reason,  fail  to  catch  combined  or  ter- 
minal consonants  will  need  special  practice  in  pronouncing  m, 
w>  th>  S>  etc  Here  the  phonetic  exercises,  associated  with 
primary  reading,  are  invaluable,  and  should  precede,  by  several 
years,  those  of  the  ordinary  spelling  classes,  which  as  being  more 
abstract,  tend  to  break  up,  and  to  dissociate  rather  than  to  coordi- 
nate sounds.  The  pupils  should  be  encouraged  to  dictate  words 
upon  a  given  sound  or  combination  of  sounds.  Emulation  soon  calls 
forth  a  dozen  or  more  words  which,  repeated  in  concert,  printed  and 
written,  gives  not  only  vocal  and  writing  practice,  but  affords  oppor- 
tunity for  the  detecting  of  individual  defects  in  pupils  who  should 
then  receive  additional  training  in  a  special  articulation  class.  The 
cause  of  the  speech  defect  is  sometimes,  as  with  normal  children,  a 
careless  habit  in  the  use  of  the  organs  of  speech  due  to  lack  of  train- 
ing, often  to  the  execrable  practice  of  persisting  in  "  baby  talk." 
Any  of  these  faulty  habits  may  be  corrected  by  exercises  suited  to 
the  needs  of  the  pupil — exercises  that,  so  to  speak,  loosen  up  the 
organs.  To  illustrate:  I,  and  r,  being  difficult  sounds,  let  the 
child  begin  with  the  syllable  "la,"  "la,"  "la,"  repeated  in  rapid 
succession,  and  then  continue  through  the  vowel  sounds.  Next 
combine  the  I,  with  consonants :   dl,  pi,  etc.,  taking  later  r,  through 


TRAINING   AND   TREATMENT.  1 43 

the  same  combinations  until  the  "  curlecl-over  "  position  of  the  tongue 
becomes  in  a  measure  automatic. 

Lisping  is  quite  common,  as  is  the  substitution  of  d  or  / 
for  th,  giving  "  dis,"  for  this,  "  fing,"  for  thing.  It  is  not  com- 
monly understood  that,  in  addition  to  the  general  bracing-up  of  the 
whole  physique  through  physical  exercises ;  special  movements  of 
head,  neck  and  shoulders,  tending,  as  they  do,  to  strengthen  and 
invigorate,  will  materially  assist  both  imperfect  speech  and  dulled 
hearing.  Weak  muscles  may  cause  either  stiffness  or  flabbiness  of 
the  lips  or  tongue,  and  the  child  may  seem  powerless  to  relax  or 
contract;  here  stimulus  through  the  emotions  is  needed.  One 
teacher  found  a  whistle  an  excellent  aid;  another,  a  bit  of  candy 
pulled  by  a  string  from  between  the  lips — the  effort  to  hold  on  in- 
ducing power  of  contraction  of  the  lips.  So,  also,  the  child  may 
place  his  hand  against  the  throat  of  the  teacher  in  order  to  learn 
and  imitate  the  action  in  sounding  g;  or  feel  the  breath  from  the 
lips  upon  the  hand  in  the  explosive  ch  or  ;'. 

A  useful  practice  drill  is  found  in  apt  alliterations,  such  as 
"  Around  the  rugged  ruin  the  ragged  rascal  ran  "  ;  "  The  twister  in 
twisting  would  twist  him  a  twist " ;  "  Shrewd  Simon  Short  sewed 
shoes."  The  words  "  Separate,"  "  February,"  "  Academy,"  as  neces- 
sitating distinctness  in  enunciating  vowel  and  consonant  sounds,  have 
been  found  good  test  words  in  examining  for  speech  defect. 

Stammering,  although  not  frequent  among  defectives  is  occasion- 
ally encountered,  and  may  be  corrected  by  early  attention  and  per- 
sistent training.  It  is  often  accentuated  by  embarrassment  and 
overhaste  in  speaking,  a  nervous  dread  producing  the  very  result 
one  seeks  to  escape. 

Dr.  Wyllie,  to  whose  work  Dr.  Ireland  first  called  my  attention, 
considers  stammering  due  to  deranged  innervation,  causing  loss  of 
command  of  the  laryngeal  mechanism  usually  felt  in  the  first  syllable 
of  words.  The  energy  needed  for  enunciation  flows  in  many  direc- 
tions, and  the  action  of  the  tongue  and  that  of  the  lips  are  not  timed 
equally ;  that  is,  the  energy  may  be  produced  irregularly,  or  at  least 
not  spontaneously,  lack  of  coordination  being  the  natural  result,  and 
this  with  highly  nervous  persons  would  be  increased  by  embarrass- 
ment or  by  hypersensitiveness.     Exercises  in  quiet  speaking,  talking 


144  TRAINING   AND   TREATMENT. 

without  effort,  should  alternate  with  the  singing  of  words  with  dis- 
tinctness. In  this  latter  the  organs  are  induced  to  maintain  one  posi- 
tion for  a  brief  space  precluding  haste.  The  voice  thus  prolonged 
gains  confidence,  and  the  power  of  enunciation  once  made  patent, 
continued  and  persistent  practice  finally  overcomes  or  at  least  modi- 
fies defect. 

The  Low-Grade  Imbecile,  the  first  capable  of  advance  from  mere 
improvement  to  actual  training,  is  a  step  in  the  ascending  scale 
from  the  idio-imbecile,  mainly  in  the  faculty  of  articulate  speech ; 
but  the  very  little  added  power  of  consecutive  thought,  however, 
is  betrayed  in  his  short,  half-expressed  sentences  or  in  a  parrot- 
like chatter.  With  halting  walk,  characteristic  dragging  foot- 
step, dulled  sight  and  hearing,  and  insensitive  touch;  for  him  the 
chief,  we  might  almost  say  the  only,  avenue  of  development  is 
through  the  muscular  sense.  Like  the  idio-imbecile,  he  cannot 
comprehend  artificial  signs  or  symbols,  and  can  never  learn  to  read 
or  write.  Figures  for  him  have  no  meaning,  nor  numbers  beyond 
the  very  simplest  counting  acquired  in  the  repetition  of  some  simple 
task,  such  as  knitting,  netting,  and  the  like.  The  excitation  of  in- 
terest in  these,  which  will  also  give  hand  and  arm  power ;  the  arous- 
ing of  the  sluggish,  indolent  will  through  the  stimulus  of  the  satis- 
faction of  doing  for  some  one ;  and  the  physical  development  by 
means  of  the  various  drills  and  occupations,  are  all  that  school  can 
do  for  him.  By  means,  however,  of  physical  exercises  that  arouse 
and  of  occupations  that  interest,  the  arm,  the  hand,  and  the  fingers 
may  be  enticed  into  movements  that,  if  coordinated  and  persisted  in, 
may  in  time  produce  a  mental  impression. 

The  ordinary  household  occupations,  which  include  the  lifting  of 
weights,  drawing,  pulling,  stretching,  rubbing  and  climbing  should 
alternate  with  the  quieter  occupations  giving  hand  and  finger  move- 
ment, and  thus  form  for  him  a  distinct  industrial  training.  The  care 
of  the  school-room  therefore,  and  of  plants,  and  the  polishing  of 
floors  and  of  windows,  are  as  distinctly  aids  in  the  work  as  are  the 
sewing  and  winding  of  strips  for  carpet-weaving,  the  folding,  the 
knitting,  the  knotting  and  twisting  of  fiber,  or  straw  braiding. 


TRAINING   AND   TREATMENT.  I45 

As  soon  as  limited  capacity  for  independent  action  is  evidenced, 
from  this  grade  may  be  drawn  fairly  responsible  aids  for  farm  or 
household  service ;  or  growing  powers  of  observation,  perception 
and  reproduction  may  find  satisfaction  in  the  use  of  the  more  per- 
manent textile  materials,  willow,  rope  or  rattan,  and  thus  as  domestic 
servants  or  as  weavers  of  carpets,  baskets,  hammocks  or  mats,  these 
children  go  out  from  school  to  contribute  their  quota  to  the  general 
economy. 

As  they  develop  two  types,  either  extreme  docility  or  perversity — 
the  one,  quiet,  gentle,  obedient,  following  any  suggestion ;  the 
other,  obstinate,  indolent,  often  brutal  and  cruel — the  necessity  for 
constant  guardianship  is  self-evident. 

Some  idea  of  the  amount  of  labor  that  must  be  expended  on  this 
grade  of  defectives  may  be  gained  from  the  following:  I  find  in  our 
museum  of  educational  work  a  little  ball,  which  I  am  inclined  to  re- 
gard as  the  most  valuable  thing  in  the  whole  collection.  The  boy  who 
made  it  was  a  low-grade  imbecile;  his  hand  against  every  man,  he 
fancied  every  man's  hand  against  him.  Always  under  strict  custody 
that  he  might  harm  neither  himself  nor  others,  he  would  vent  his 
spleen  in  tearing  his  clothing.  His  teacher,  a  woman  of  rare  patience 
and  devotedness,  sat  beside  him  one  day,  tearing  strips  of  old  linen  and 
laying  them  in  order.  "  See,  Willie,  let  us  make  some  pretty  strips 
and  lay  them  so."  His  wonder  grew  apace  at  seeing  her  do  what 
he  had  been  reproved  for  doing.  At  once  he  responded,  and  a  new 
bond  of  sympathy  was  established  between  them.  She  was  playing 
his  game — the  only  one,  poor  little  lad,  that  he  was  capable  of — 
and  he  joined  in.  "  Now  we  will  draw  out  the  pretty  threads  and 
lay  them  in  rows."  For  weeks  the  boy  found  quiet  pastime  in  this 
occupation,  and  the  violent  nature  grew  quieter  in  proportion.  One 
day  the  teacher  said,  "  Let  us  tie  these  threads  together,  and  make 
a  long  string."  It  took  him  months  and  months  to  learn  to  tie  those 
knots,  but  meanwhile  his  attendants  were  having  "  breathing  space." 
"  Now  we  will  wind  this  into  a  pretty  ball,  and  I  will  cover  all  you 
make  for  the  boys  to  play  with  " ;  and  a  new  occupation  was  added 
to  his  meager  list.  The  next  link  in  this  chain  of  development  was 
a  lesson  in  knitting.  Again,  through  months  of  patient  teaching,  it 
was  at  last  accomplished,  and  the  boy  to  the  day  of  his  death  found 
10 


I46  TRAINING  AND  TREATMENT. 

his  life-happiness  in  knitting  caps  for  the  children  instead  of  tearing 
both  them  and  their  clothing.  In  this  case  the  teacher  was  wise 
enough  to  utilize  the  natural  activities  of  the  child  and  to  divert  evil 
propensities  into  healthful  channels.  Had  she  brought  knitting  and 
bright  yarn  or  anything  foreign  to  him  first,  it  would,  in  truth,  have 
been  fitting  new  cloth  to  old  garments,  and  the  rent  would  have 
been  widened ;  his  obstinacy  would  have  been  aroused,  and  he  would 
have  continued  to  tear  to  the  end  of  the  chapter. 


The  Imbecile  of  Middle-Grade  should  receive  that  fuller  presenta- 
tion of  work  suited  to  fuller  capacity.  For  him  the  working  hand 
must  still  make  strong  the  working  brain,  through  means  which  his 
brother  dullard  is  not  yet  equal  to ;  some  knowledge,  too,  of  the 
three  R's  he  is  also  capable  of  acquiring  and  of  applying,  and  al- 
though to  but  a  limited  extent,  that  much  he  should  have.  Not  only 
because  the  knowledge  gained  is  of  immediate  practical  use  as  an 
aid  in  other  class  work,  but  direct  benefit  of  daily  quiet  occupation 
with  books,  papers  and  blackboards  is  incalculable  to  nervous,  rest- 
less natures  that  for  two  thirds  of  the  day  are  engaged  in  those  man- 
ual and  industrial  employments  in  which  they  must  find  their  chief 
means  of  development. 

Reading,  to  which  both  spelling  and  writing  are  but  subsidiary 
aids,  is  best  acquired  by  the  word-method  based  upon  conversation. 
Attention  is  attracted  and  held  by  the  presentation,  if  possible,  of 
the  object  pictured  in  chart,  and  also  sketched  rapidly  on  the  board  by 
the  teacher,  while  in  easy  conversation,  short  descriptive  sentences 
are  elicited  from  the  children,  each  contributing  his  story,  the 
teacher  printing  and  writing  these  in  corresponding  columns  at  their 
dictation.  Beginning  then  at  the  end  of  the  sentence,  teacher  and 
pupils  call  words  in  concert  until  by  alternate  retreat  and  return  the 
words  in  both  columns  have  been  repeatedly  named  and  the 
stories  read  through  in  conversational  tone  from  beginning  to 
end.  Similar  stories  are  then  looked  up  on  the  chart  and  dif- 
ferences noted,  and  after  reading  these  in  the  same  manner,  the 
class — while  the  mental  impression  is  still  fresh — is  dismissed  to 
blackboards  to  reproduce  the  lesson  in  drawing,  print  and  script, 
each  child  reading  result  aloud  before  returning  to  seat.     Any  effort 


TRAINING   AND   TREATMENT.  1 47 

however  crude — as  it  will  be  at  first — will  grow  through  encourage- 
ment and  emulation. 

To  facilitate  progress  and  to  give  requisite  practice  in  forming 
letters  there  should  be  a  daily  drill  of  not  less  than  twenty  minutes. 
The  children,  going  immediately  upon  entering  the  school-room  to 
blackboards,  gain  a  certain  self-reliance  by  putting  themselves  to 
work  and  not  depending  always  upon  call.  The  class  working 
silently  filling  blackboards  a  few  times  will  first  print  several  letters 
in  columns;  then  erasing,  will  write  the  same,  rapidly  changing 
order  of  letters  to  vary  arm  and  finger  movement,  thus: 
abc  bca  cab 

abc  bca  cab 

abc  bca  cab 

On  Friday  the  blackboards  should  show  the  work  of  the  week  in 
print,  in  script,  and  also  in  drawing,  and  when  any  of  these  are 
esteemed  worth  preserving,  and  pencils  and  paper  begin  to  be  dis- 
tributed, the  turning  point  with  two  R's  is  reached  and  an  atmo- 
sphere of  competition  pervades  the  room  where  reading  and  writing 
is  fairly  begun.  Having  thus  gained  a  familiarity  with  the  appear- 
ance of  letters  in  the  concrete  form  of  words,  the  alphabetic  names 
having  been  gained  incidentally  in  the  writing  and  printing,  their 
sounds  are  next  sought  by  analyzing  words  in  daily  phonetic  exer- 
cises, as  the  only  road  to  correct  spelling.  Again,  the  class  will 
originate  and  build  up  the  lesson  of  the  day,  giving  words  contain- 
ing the  single  or  composite  sound.  Thus  the  teacher  will  say: 
"  Let  us  make  words  that  hiss,  with  this  letter,"  indicating  but  not 
naming  the  letter  .? ;  the  class  in  response  gives  "  six,  song,  sum." 
"Now  with  this  sound,"  indicating  si;  and  the  children  give 
"  slow,  sling,  slip,"  etc.  A  dozen  or  more  such  words,  printed  and 
written  by  the  teacher  and  rapidly  called  by  the  class,  after  satisfac- 
tory blackboard  reproduction  may  be  transferred  to  paper  to  form 
the  basis  of  weekly  review  and  of  original  sentence  building.  The 
simultaneous  training  of  eye  and  ear  is  here  stimulated  by  the  grati- 
fication of  the  natural  desire  of  the  child  to  separate  into  parts,  to 
investigate  and  rebuild.  The  completion  of  a  required  number  of 
papers,  together  with  rapid  sight  reading  of  the  words  and  phrases, 
wins  promotion  to  a  book  and  opens  to  the  first  class  the  "  First 


I48  TRAINING   AND   TREATMENT. 

Reader."  The  method  pursued  with  it,  however,  is  the  same,  arriv- 
ing by  repeats  to  beginning-  from  end  of  sentence,  reading  always  in 
concert.  The  class  gradually  may — in  two  divisions — take  para- 
graphs alternately,  but  not  until  a  review  of  the  entire  book,  may 
independent  reading  be  expected.  The  "  Third  Reader  "  marks  usu- 
ally the  limit  of  capacity. 

The  same  plan  of  proceeding,  from  concrete  to  abstract,  is  pur- 
sued in  teaching  arithmetic.  As  in  this  branch  much  depends  upon 
a  clear  conception  in  the  beginning,  the  manner  of  approach  is  every- 
thing. In  observing  the  predilection  always  evinced  by  children  for 
things  in  quantity,  it  has  been  found  that  number  is  more  attractive 
when  presented  in  groups  as  a  synthetic  whole.  The  number  idea 
thus  attained  is  followed  with  most  ease  through  reduplication  or 
subdivision  of  groups,  and  the  unit  finally  reached  thus  linked  with 
association  is  not  so  entirely  abstract.  The  second  step  of  combin- 
ing and  counting  has  likewise  its  attraction  and  association  of  return 
to  the  original  groups.  There  are  enthusiasts  in  child-study  who 
affirm  that  the  child's  first  number  concept  and  numeral  frame  is 
found  in  its  cradle-play  with  the  ten  fingers,  and  that  therefore  the 
decimal  system  of  computation  is  the  natural  method  and  the  most 
direct.  Be  this  as  it  may,  it  is  certain  that  any  suggestion  of  avoid- 
ing the  fatigue  of  mere  circumlocution  is  to  be  welcomed  by  a 
teacher  of  the  feeble-minded,  knowing,  as  she  does,  how  much  must 
be  accomplished  in  a  brief  period,  and  that  the  minds  of  her  pupils 
must  be  trained  and  yet  not  strained  by  the  study  of  numbers.  With 
many  young  children — normal  and  abnormal — who  count  most 
glibly,  the  number  concept  is  either  wanting  or  limited  to  that  gained 
through  familiar  use  of  certain  objects,  such  as  the  parts  of  the 
body,  the  possible  divisions  of  an  apple,  the  windows  of  the  room, 
etc.  Upon  this  foundation,  therefore,  the  teacher  must  begin  to 
build,  working  from  the  known  to  the  unknown.  Let  the  child 
place  in  two  groups  as  many  cards  as  he  has  fingers.  Telling  the 
story  of  ten  in  two  he  finds  five.  Reuniting  he  next  places  his 
ten  in  five  groups  and  finds  two  in  each.  Reuniting  again  and 
placing  separately  he  finds  ten  ones.  After  repeated  exercises  like 
this  he  will  be  eager  to  put  his  work  on  the  board  and  learns  to 
transcribe  the  work  from  desk  to  board  and  write  the  story  thus : 


Plate  XXV. 


Case  J.  Case  K. 

MORAL   IMBECILES— MIDDLE-GRADE. 


TRAINING   AND    TREATMENT.  I49 

io-r-2  =  5;  10^-5  =  2;  5  +  5  =  10;  10  —  5  =  5;  io-t-io=i; 

1  +  1-fi  +  i-f  1  +  1  +  1  +  1  +  1  +  1  =  10;  etc. 

Another  time  he  finds  that  two  cards  added  to  his  original  ten 
will  give  him  a  number  that  he  can  separate  into  many  stories, 
and  the  various  combinations  of  twelve  are  opened  up  in  the  same 
way.  Thus  in  each  story  told,  he  will  find  material  for  a  new 
one,  and  so  by  repeated  daily  practice  he  becomes  familiar  with 
number  in  varied  and  distinct  operations  associated  with  correspond- 
ing figures  and  signs  by  original  and  independent  action.  As  fa- 
miliarity increases,  action  becomes  almost  automatic,  and  a  class  thus 
trained  is  enabled  to  take  rapid  dictation  with  plus  and  minus  signs, 
often  including  simple  fractions,  such  as  :  3^  +  4^2  —  4  +  2  —  3. 
Such  examples  the  pupil  is  required  to  illustrate,  if  only  in  simple 
lines  or  dots,  both  aiding  and  verifying  his  work,  which  must  be 
read  aloud  before  transcribing.  Daily  practice  soon  promotes  rapid 
reading  with  rapid  mental  computation,  giving  solution  of  foregoing 
problem,  thus  :  3^  8463.  Conceptions  of  quantity  and  of  meas- 
urement progress  in  the  same  way  from  the  gallon  to  the  quart  and 
pint ;  from  the  dozen  to  the  half-dozen ;  the  fractions  of  the  dollar 
come  naturally  to  him,  and  from  the  foot-rule  he  discovers  the  value 
of  the  inch.  In  the  beginning  of  constructive  work,  the  square  is 
to  him  a  unit  which  by  half  and  quarter  foldings  he  reduces  to 
inches  and  finds  by  practical  experiment  that  his  box  one  inch  deep 
is  two  inches  wide  and  two  long.  As  the  number  idea  deepens 
through  practical  experience,  still  working  with  objects,  he  will  be- 
come able  to  discover  and  state  how  he  must  get  out  card-board  for 
a  box  six  inches  long,  four  wide  and  two  deep,  thus :  "  I  must  have 
depth  plus  the  length,  plus  the  depth  again,  2"+ 6" +  2"=  10",  and 
depth  plus  width  plus  depth  again,  2"+4"+2"=8".  So  my  card- 
board must  be  8"  x  10"."  As  two  hours  are  daily  given  to  construc- 
tion work  with  both  wood  and  card-board — the  latter  including  fur- 
niture, toys  and  boxes  in  various  geometric  forms — there  is  ample 
suggestion  for  original  problems  which  should  also  show  sketch 
and  working  drawing.  Not  an  unimportant  part  of  class-work  is 
the  making  of  all  exercise  books  and  the  portfolios,  the  laying  off 
of  the  papers  giving  daily  practice  in  dividing  in  fractional  parts 
and  in  practical  measurements.     Materials  required  are :  rulers,  pen- 


150  TRAINING   AND   TREATMENT. 

cils — never  pen  and  ink — a  few  brass  clips,  some  colored  tape  or 
ribbon,  charcoal  with  a  fixative,  colored  chalk  or  water  color  for 
decoration,  a  bundle  of  ordinary  manilla  paper  and  one  also  of  the 
heaviest,  toughest  wrapping  paper  without  gloss,  of  a  shade  to  take 
color  well,  and  which  will  fold  and  crease  easily  without  breaking. 
The  child  is  to  be  taught  thrift  and  carefulness  from  the  very  begin- 
ning; he  may  have  all  the  material  he  wants  to  use,  but  none  to 
waste  or  abuse.  Thus  he  will  have  to  consider  how  the  large  sheet 
will  best  divide  equally  into  a  number  of  smaller  ones,  and  this  divid- 
ing in  halves,  fourths,  eighths,  etc.,  soon  becomes  automatic.  The 
page  is  next  to  be  so  portioned  off  in  thirds  or  fourths  as  to  leave 
a  proper  heading,  and  an  inch  or  so  for  margin  upon  which  writing 
must  not  trench,  is  to  be  accurately  measured  and  carefully  lined. 

The  number  of  sheets,  be  they  few  or  many,  accomplished  in  any 
one  study  during  the  month  constitute  a  book,  and  here  is  another 
source  for  emulation.  The  book  fastened  at  top  with  pins  or  rib- 
bon will  need  a  cover,  which  calls  for  further  exercise  of  judgment 
in  measurement  and  careful  cutting,  while  the  imagination  is  quick- 
ened in  the  designing  of  decoration.  The  pleasure  of  competition 
and  the  excitement  of  fresh  beginning  adds  a  zest  to  work,  and  the 
sense  of  possession  is  gratified  by  viewing  an  ever-increasing  store ; 
while  the  habits  of  thrift,  of  deftness  and  of  particularity  acquired  in 
practice  with  simple  material  will  be  invaluable  in  the  sloyd  class, 
where  he  is  working  with  wood  and  handling  tools.  Illustration 
and  decoration,  however  simple,  should  be  encouraged,  not  only  as 
another  means  of  thought  expression,  but  also  as  being  a  direct 
application  of  the  lessons  in  drawing  and  modelling.  Indeed  for 
these  children  of  middle  grade,  so  slow  in  grasping  or  using  artifi- 
cial signs,  it  is  to  the  broader,  more  apparent  harmonies  of  form 
and  color  that  we  must  look  for  that  cultivation  of  the  aesthetic 
sense  which  those  of  high  grade  are  able  to  gain  in  musical  harmony 
and  rhythm.  The  influence  of  both  upon  the  life  is  not  only  to 
harmonize  and  to  refine,  but  the  daily  concentration  of  effort  to 
modify,  to  adjust  and  to  adapt ;  to  change  discord  to  harmony ;  to 
intensify  color  or  to  soften  effects ;  to  join  or  to  fit  things  one  into 
another ;  to  make  rough  places  smooth  and  the  crooked  straight ;  must 
tend  to  established  habits  moral  and  intellectual  which  cannot  fail 
to  mould  and  to  build  up  character. 


TRAINING   AND   TREATMENT.  I  5  I 

Manual  training,  to  children  of  middle  grade  especially,  comes 
with  an  active  vivifying  power.  Utilizing  the  love  of  tools,  inher- 
ent in  the  child,  it  attracts  his  attention  rather  than  compelling  it 
by  superimposition ;  it  concentrates  that  attention  and  bends  it,  in 
the  first  place,  upon  the  teacher  and  the  class  instruction,  or  he 
cannot  know  what  to  do;  next,  upon  himself,  imposing  a  careful 
outlook  lest  he  injure  himself  with  tools,  and  finally,  upon  the  work 
itself,  to  bring  it  to  successful  completion. 

Relieving  this  tension,  the  work  requires  constant  movement  of 
the  body,  but  while  thus  physically  and  mentally  active,  the  child 
is  still  never  free  from  the  consciousness  of  a  necessity  for  intelli- 
gent observation;  and  practical  judging  and  logical  thinking  becomes 
thus  a  coincident  growth.  The  rule  and  the  try-square  prove  in- 
valuable agents  not  only  in  forming  habits  of  testing  ability  and 
deterring  therefore  from  over-confidence  and  self-conceit,  but  in 
producing  an  abiding  impression  of  the  necessity  for  truthfulness. 
In  this  it  forms  a  logical  sequence  to  the  kindergarten  idea  of  occu- 
pations. Introduced  as  early  as  possible  into  the  school  period,  it 
will  prove  equally  a  wholesome  relaxation  from,  and  the  best  prep- 
aration for,  the  purely  mental  exercises  of  the  school-room.  It  is 
in  such  personal  activities  that  the  average  child  can  best  demon- 
strate his  own  individuality  and  satisfactorily  prove  to  himself  and 
to  others  the  power  within  him,  while  on  the  other  hand  this  power 
of  doing,  gained  at  an  early  age,  inspires  a  love  of  work  that  best 
fits  the  individual  for  the  exigencies  of  life.  And  yet  the  aim  is 
not  to  teach  how  to  make  a  living,  but  how  to  live;  for  instance,  it 
does  not  teach  carpentry  or  any  hand-work  as  a  tradey  nor  the 
making  of  pictures  as  a  mere  accomplishment,  but  it  utilizes  tools 
and  exercises  as  a  means  of  giving  the  child  an  impression  of  real 
work  that  will  awaken  and  develop  in  him  an  inclination  toward  all 
forms  of  occupation ;  to  discern  beauty  and  to  apply  it.  New  op- 
portunities are  always  open  for  growing  strength  and  capacity ;  the 
building  of  artistic  furniture  will  include  experience  in  the  treat- 
ment and  preservation  of  wood,  the  use  of  filling,  shellac,  paint,  var- 
nish and  oil.  For  decoration  there  must  be  training  in  modelling, 
drawing,  painting,  carving,  and  designing,  and  dexterity  in  applying 
design ;  and  with  knowledge  of  these,  new  fields  open  up  in  the  arts 


152  TRAINING   AND   TREATMENT. 

of  pottery  and  metal  working.  It  is  by  this  broadening  of  thought 
and  strengthening  of  will,  through  self-activity,  that  manual  train- 
ing prepares  the  child  to  enter  upon  any  of  the  avenues  to  a  life 
purpose  opened  to  him  in  the  trades,  be  it  shoe-making  or  tailoring, 
carpentry  or  house  painting,  basketry  or  pottery ;  or  the  decorative 
arts,  such  as  embroidery,  carving  or  illustrating,  which  the  training 
with  needle,  chisel,  mallet  or  brush  further  includes.  Various  meth- 
ods are  means  to  this  end. 

Sloyd,  or  slight  of  hand,  a  system  devised  in  Finland  and  in- 
troduced in  the  schools  of  neighboring  countries  and  also  in  America, 
offers  as  its  distinguishing  feature,  progressiveness.  Based  upon 
the  idea  that  tool-work  gives  a  dexterity  to  the  hand  that  will  be 
useful  in  any  vocation,  a  series  of  carefully  graded  models  are 
so  arranged  that  each  step  with  a  new  tool  calls  for  a  different  mus- 
cular exercise.  The  lesson  follows  the  same  line  as  that  previously 
rehearsed  for  teaching  reading.  The  teacher  explains  model,  makes 
before  the  class  a  working  drawing,  and  each  pupil  then  making  his 
own  drawing,  works  it  out.  The  models  begin  with  the  simplest 
articles  of  everyday  life — a  window-wedge  or  a  flower-stick — that  can 
be  made  with  the  knife,  the  simplest  of  tools. 

The  next  step  is  to  the  bench,  where  pencil,  rule,  and  bench-hook 
form  the  basis  of  what  is  to  be  a  gradually  increasing  store  of  tools. 
Numerous  models  give  opportunity  for  such  lengthened  practice  with 
one  tool  as  the  capacity  of  the  pupil  may  demand,  instead  of  dull- 
ing interest  by  a  monotonous  repetition  of  one  thing.  Each  step 
with  a  new  tool  aims  to  quicken  simultaneously  thought  and  muscu- 
lar activity ;  thus  the  plane  and  the  various  saws  exercise  differently 
the  muscles  of  the  forearm  and  shoulders ;  the  drill-bit  in  boring, 
and  the  hammer  in  driving  require  each  a  different  movement,  and 
each  and  all  demand  observation  from  different  standpoints.  So  also 
through  the  various  models,  bringing  in  the  use  of  the  pencil-com- 
pass and  turning-saw  working  in  curves  and  circles,  and  the  spoke- 
shave  and  file  in  working  down  edges,  the  underlying  principle  of 
the  models  prepared,  stands  for  progression  from  simple  to  complex, 
from  concrete  mass  to  abstract  line.  Elaboration,  modification  and 
even  change  of  models,  adapting  them  to  immediate  environment  or 
to  any  peculiarity  of  the  child,  is  advisable,  provided  such  models  do 
not  depart  from  basic  principles. 


Plate  XXVI. 


[3  1  1 


Case  C.  Case  D. 

MORAL  IMBECILES— HIGH-GRADE. 


TRAINING   AND   TREATMENT.  I  53 

For  this  work  of  invention,  for  experimentation  in  pattern  mak- 
ing, as  well  as  for  general  practice,  the  preparatory  class  of  paper- 
sloyd  offers  excellent  opportunity,  it  being  easier  to  demonstrate  an 
idea  in  pliable  cardboard  than  in  the  more  resisting  wood.  Here 
the  use  of  the  rule,  the  try-square  and  large  shears  in  the  prepara- 
tion of  material,  and  the  bending  of  heavy  paper  in  the  manufac- 
ture of  various  useful  articles — portfolios,  wall-pockets,  picture 
frames,  etc.,  is  a  direct  advance  upon  the  paper  folding  of  the  kinder- 
garten ;  and  the  use  of  heavy  cardboard  in  the  construction  of 
workstands,  brackets,  tabourets  and  toy  furniture  of  considerable 
size,  necessitating  the  use  of  knife  and  saw,  of  glue  and  shellac, 
approximates  and  prepares  for  as  well  as  affords  practice  in  the 
work  of  the  regular  sloyd  bench.  While  in  construction  work  the 
two  systems,  kindergarten  and  sloyd,  are  each  the  supplement  and 
complement  of  the  other,  there  is  found  a  distinct  hiatus  in  the 
training  of  the  esthetic  sense.  The  child,  fresh  from  the  sensuous 
color  and  beauty  forms  he  has  worked  out  in  the  many  tints  and 
shades  of  paper  and  plastic  clay,  has  had  glimpses  of  possibilities 
which  are  not  realized  in  the  monotony  of  neutral  color  and  unbroken 
surface  that  meets  him  here.  It  cannot  be  denied  that  in  practical 
means  for  decoration,  in  giving  to  the  hand  the  power  of  the  artist 
together  with  the  skill  of  the  artisan,  sloyd  beyond  the  beauty  of 
truth  and  precision  has  made  no  provision.  As  one  of  its  most 
earnest  advocates  acknowledges :  "  The  most  difficult  thing  that 
confronts  a  sloyd  teacher  is  to  make  the  problem  in  wood  sufficiently 
simple,  at  the  same  time  beautiful  in  form  and  interesting  to  the 
child.  For  this  reason  it  is  important  that  the  teachers  of  sloyd 
and  of  art  should  work  together  in  order  that  nothing  but  the  best 
objects  and  illustrations  be  presented  to  the  children." 

It  is  interesting  here  to  compare  two  systems  that  approach  the 
subject  from  opposite  standpoints ;  one  begins  where  the  other  leaves 
off.  Both  are  based  upon  correct  pedagogic  theory.  In  both  the 
emotions  and  natural  activities  are  utilized  for  a  three-fold  develop- 
ment— mental,  moral  and  physical — and  in  both  the  environment  sug- 
gests the  models  for  education  through  the  hand ;  but  the  models 
of  one  drawn  through  the  interior  home  world  are  designed  to  work 
upward  and  onward  with  a  growing  experience  by  means  of  con- 


154  TRAINING   AND   TREATMENT. 

struction  toward  the  beautiful  in  art  and  nature,  for  which,  how- 
ever, it  would  send  its  pupils  to  other  schools.  It  is  sound,  it  is 
practical,  but  it  is  also  utilitarian. 

The  other  takes  models  from  the  outer  world — the  circle  of  the 
horizon,  the  moon  or  the  flower,  and  all  the  forms  of  plant  and  ani- 
mal life ;  reproducing-  and  conventionalizing  with  the  ultimate  aim 
of  beautifying  and  decorating  the  house,  for  the  building  of  which  it 
does  not  begin  early  definitely  to  prepare.  It  has  breadth,  it  has  cul- 
ture, it  has  beauty,  which  is  life.  Its  pupils  could  early  make  of 
a  cabin  a  home  of  delight,  but  they  might  not  at  the  same  stage  be 
able  to  build  a  shelter  from  the  storm.  This  latter,  a  system  of  edu- 
cation through  the  hand,  originating  in  America  and  already  adopted 
in  some  of  its  large  centers  has,  like  sloyd,  also  crossed  the  Atlantic 
and  has  met  with  favorable  consideration  in  both  England  and  Ger- 
many. Having  its  foundation  in  nature  study,  its  models  are  nearly 
all  derived  from  that  source,  including  an  alphabet  of  design  to  be 
developed  in  the  ambidextrous  movements  of  free-hand  drawing 
which  are,  as  before  stated,  associated  with  physical  exercises.  Re- 
production of  models  and  of  original  design  is  encouraged  in  draw- 
ing, in  color,  and  in  modelling  in  clay,  in  plaster,  and  in  wood. 
Constructive  work  includes  joinery  and  cabinet  work,  and  metal 
working;  this  latter,  however,  is  not  sufficiently  coincident  with  the 
former  to  secure  well-rounded  development,  and  in  the  providing  so 
largely  for  decoration  before  entering  upon  construction,  the  system 
is  somewhat  illogical.  Broader  in  its  scope  and  fuller  than  sloyd 
in  its  nature  study,  esthetic  training,  and  art  models,  it  yet  needs 
to  deepen  in  devising  and  providing  those  that  relate  to  the  practical 
and  material  life.  Simplicity  and  freedom  from  complexity  and  ex- 
cessive detail  and  cheapness  of  material  commend  this  system. 
Blackboards  and  manilla  paper,  clay,  chalk,  charcoal  and  water  color, 
wood  and  some  few  tools,  place  it  within  reach  of  all,  and  for  models 
there  is  the  whole  outside  world.  By  modifying  and  combining  the 
two  systems,  we  have  been  able  to  secure  methods  admirably  adapted 
to  the  training  of  feeble  minds. 

High-Grade  Imbeciles  who  have  the  advantage  of  kindergarten 
training,  acquire  by  means  of  its  various  occupations  clear  concep- 


TRAINING   AND   TREATMENT.  I  55 

tions  of  form,  color,  and  much  practice  in  numbers.  As  the  kinder- 
garten period  in  most  training  schools  for  defectives  is  not  only 
prolonged  beyond  the  ordinary  three-year  term,  but  is  further  modi- 
fied into  a  daily  five-hour  system,  facility  in  reading  and  writing  is 
also  gained  here  by  these  children,  by  methods  more  condensed  and 
in  less  detail  than  those  which,  as  we  have  noted,  the  middle-grade 
child  must  laboriously  pursue  generally  after  entering  the  school 
proper.  Yet  even  with  this  preparation  not  only  is  it  inexpedient 
for  these  children  to  attempt  to  pursue  purely  mental  work  further 
than  the  ordinary  intermediate  or  the  grammar  school  course,  but 
these  must  be  a  modification  of  that  course ;  some  studies  omitted 
altogether,  and  others  so  attractively  presented  as  to  make  a  mental 
impression  sufficiently  strong  to  induce  satisfactory  reproduction 
without  causing  undue  effort  or  fatigue  to  the  pupil.  As  independ- 
ent study  during  prolonged  periods  is  for  feeble  minds  an  absolute 
impossibility,  some  plan  other  than  successive  memorizing  and  reci- 
tation must  be  devised,  and  here  as  in  the  kindergarten,  the  teacher 
must  live  with  and  work  with  her  children.  Quick  to  notice  indi- 
vidual needs,  she  must  be  equally  rapid  and  original  in  adapting 
methods  to  the  case  in  hand ;  in  other  words,  she  must  use  her  meth- 
ods for  the  benefit  of  the  pupil — not  be  enslaved  by  them  to  his 
detriment. 

As  many  of  the  class  must  devote  a  large  portion  of  the  day  to 
music  practice,  to  manual,  industrial,  and  physical  exercises,  and  to 
military  drill,  the  time  allotted  to  purely  abstract  mental  work  should 
not  be  wasted  in  a  mere  turning  of  leaves.  Books,  which  should  be 
attractive  in  binding  and  type  and  well  illustrated,  are  best  utilized 
as  reference  for  gaining  additional  information  upon  subjects  that 
have  been  previously  presented  in  object  lessons  of  minerals,  of  plant 
and  animal  life,  of  simple  every-day  physics,  etc.  So  also  geo- 
graphical readings  should  supplement  nature  study  and  follow,  not 
precede,  a  knowledge  of  land  and  water  divisions  gained  first  hand 
from  the  child's  immediate  environment,  and  reproduced  by  him  in 
sand  and  in  clay.  Increased  familiarity  and  greater  proficiency  will 
demand  later  more  permanent  material  for  relief-forms,  and  repro- 
ductions of  these  in  flat  color  will  lead  naturally  to  the  more  abstract 
and,  therefore,  more  intellectual  work  of  drawing  maps  in  outline. 


I56  TRAINING   AND   TREATMENT. 

The  study  of  history  may  be  pursued  in  connection  often  with  geog- 
raphy, and  in  much  the  same  way.  Beginning  with  talks  on  famil- 
iar topics  and  current  events,  note-taking  may  be  encouraged;  and 
short  compositions  lead  up  gradually  to  abstracts  of  historical 
periods,  emulation  being  excited  by  competition  in  blackboard  repro- 
duction and  illustration.  This  should  be  the  constant  spur  in  mathe- 
matics also.  From  the  simplest  operations  with  objects  in  the  kin- 
dergarten on  to  problems  in  computing  interest,  volume  and  capacity, 
and  the  practical  measurements  that  the  working  drawings  in  man- 
ual training  require,  the  blackboards  should  always  present  the  best 
effort  of  the  pupil,  and  as  proof  of  advance  should  frequently  exhibit 
original  problems. 

The  love  of  music,  which  seems  the  one  clue  leading  through  the 
maze  of  the  development  of  backward  races  and  of  degenerate 
natures,  is  strongly  evidenced  among  the  feeble-minded.  Suscep- 
tible not  only  to  its  influence,  but  to  its  training,  it  is  remarkable 
how  readily  they  seem  to  absorb  rather  than  to  decipher  the  mys- 
teries of  notation,  harmony  and  rhythm.  True,  those  successful  in 
instrumental  music  are  chiefly  of  high  grade,  nevertheless  a  child 
of  middle  grade  will  frequently  evince  an  eagerness  and  perseverance 
with  notes,  in  marked  contrast  to  his  apathy  and  indifference  to  let- 
ters and  figures,  finally  relinquishing,  not  without  a  struggle,  his 
instrument,  should  it  prove  hopeless,  but  glad  to  retain  his  place  in 
a  singing  class  where  association  and  imitation  makes  the  work 
comparatively  easy  for  him. 

From  these  classes  practising  simple  songs  and  hymns  in  unison, 
and  tested  from  time  to  time  in  scales  and  intervals,  may  be  selected 
those  capable  of  advance  in  sight-reading  and  part-singing,  who  shall 
become  members  of  a  regular  musical  organization,  training  for 
band,  orchestra  or  chorus-singing,  while  contributing  at  the  same 
time  to  the  social  demands  of  community  life.  The  exercise  of  in- 
tellectual and  moral  qualities  are  thus  coincident  and  the  cultivation 
of  the  altruistic  sense  is  not  less  valuable  than  that  of  the  artistic. 
Effects  are  marked  too,  in  the  softening  of  rude,  surly  natures,  by 
the  necessity  for  association  and  constant  interdependence  required 
in  the  production  of  harmonies  with  different  instruments.  Com- 
parative simplicity,  as  well  as  convenience  in  providing  for  large 


Plate  XXVII. 


TRAINING   AND   TREATMENT.  I  57 

classes,  has  in  most  training  schools  given  the  preference  to  wind 
instruments.  The  exercise  of  the  respiratory  organs  is  another  ad- 
vantage; and,  moreover,  the  strengthening  of  facial  muscles  in  daily 
practice  has  proved  an  excellent  corrective  to  the  imperfect  enuncia- 
tion and  slovenly  habit  of  speech  common  among  the  feeble-minded. 
These  pupils  early  taking  their  parts  in  the  light  popular  airs  of  the 
day,  chiefly  for  marching  and  dancing,  come  in  time  to  render  very 
acceptably  the  music  of  such  composers  as :  Balfe,  Bellini,  Donizetti, 
Flotow,  Gounod,  Rossini,  Verdi  and  Wagner. 

There  are  not  lacking  data  to  show  excellent  results  attained  also 
with  violin,  piano,  and  even  pipe-organ  by  feeble-minded  children, 
such,  of  course — unless  perhaps  idiots  savants — being  generally  of 
high  grade,  for  where  there  has  been  failure  in  attaining  a  knowl- 
edge of  letters  and  figures,  the  mastering  of  notes  and  rhythm  is 
exceptional.  An  excellent  device  for  aiding  this  work,  however, 
is  based  upon  the  object  plan,  found  so  useful  in  training  for  number 
concept.  Notes  and  accompanying  signs  of  a  size  sufficiently  large 
to  handle,  are  cut  out  of  cardboard  and  arranged  at  will  or  from 
dictation,  on  a  staff  also  made  of  cardboard  or  of  light  wood  and 
mounted  in  a  frame.  Interest  thus  aroused  and  attention  concen- 
trated, the  arduous  task  of  learning  notes  and  relative  values  is  sim- 
plified and  transformed  into  pastime.  In  the  training  for  sight- 
reading,  various  systems  have  proved  successful,  the  Tonic  Sol-fa, 
the  Cheve,  etc.,  but  here,  as  in  every  other  line,  the  versatility  of  the 
teacher  must  arrange  and  adapt  systems  to  actual  needs. 

Such  a  class  in  sufficient  numbers  under  an  efficient  leader  may 
be  brought  to  render  with  accuracy  and  expression  both  sacred  and 
secular  music,  and  even  to  give  very  creditable  presentations  of  light 
opera.  The  mental  discipline  for  these  children  in  the  study  of 
music  fully  equals  that  which  they  gain  from  books ;  moreover  there 
is  greater  stimulus  both  in  progress  and  in  aim.  In  individual  prac- 
tice here,  just  as  in  military  and  physical  exercises,  there  is  with 
the  pupil  an  ever-present  consciousness  that  any  mistake  or  failure 
on  his  part  will  mar  the  harmony  of  the  whole,  and  seriously  affect 
the  work  of  others  in  the  test  of  the  concerted  practice,  in  which 
each  and  all  are  eagerly  interested.  Thus  both  pride  and  fear  impel 
advance  in  a  study  which  at  each  step  offers  compensation,  encour- 


I58  TRAINING   AND   TREATMENT. 

ages  to  fresh  endeavor,  and  tends  to  elevate  and  refine.  Indeed  ad- 
vance is  more  rapid,  and  mental  development  more  marked  in 
music  than  in  any  other  medium.  The  excitement  of  pleasurable 
emotion  reducing  fatigue,  places  it  more  in  the  line  of  diversion  and 
rest  from  more  strenuous  occupation.  Places  in  band,  orchestra  or 
chorus  are  eagerly  sought,  and  withdrawal  or  suspension  is  accounted 
punishment  most  severe ;  the  benefit  to  a  whole  community  of  being 
daily  brought  into  touch  with  melody  and  harmony  is  incalculable,  so 
that  as  can  well  be  seen,  music  is  an  indispensable  factor,  becoming  a 
component  part  of  community  life  as  it  is  of  the  school  curriculum. 

Of  the  Backward  or  Feebly-Gifted,  the  class  last  named  in  the 
educational  classification,  the  question  naturally  arises,  If  not  de- 
fective why  has  it  place  here?  If?  That  is  just  the  point!  Clearly, 
the  true  condition,  whether  defective  or  merely  unnatural,  re- 
mains to  be  proven,  and  is  proven  mainly  by  retrogression  or  ad- 
vance under  training.  Moreover  the  character  of  the  training  may 
itself  determine  the  question.  Fortunate,  therefore,  if  a  free  at- 
mosphere, be  it  nursery  or  kindergarten,  give  opportunity  for  self- 
expression  and  determine  the  necessity  for  special  training  before 
neglect  or  mismanagement  interfere  with  the  aim  of  that  training. 
It  may  be  a  case  that  calls  for  simply  more  time,  and  removal  from 
the  atmosphere  of  competition  that  dazes  and  stultifies  the  timid 
nervous  child.  A  prolongation  of  the  ordinary  primary  school 
course,  may  then  be  all  that  is  required  to  establish  a  certain  amount 
of  confidence  and  self-reliance,  permitting  a  return  to  regular  classes. 

Again,  lack  of  power,  of  attention,  or  of  concentration,  or  that 
general  debility  which  yields  so  readily  to  fatigue,  should  suggest 
such  modification  as  would  insure  rest  through  the  medium  of  va- 
riety and  of  change.  The  experienced  teacher  working  with  the 
watchful  physician  may  later  find  the  elective  course  the  only  one 
possible,  providing  always  for  physical  training  and  exercise,  and  for 
broad  mental  culture  rather  than  for  study  on  close  lines.  The 
energy  as  it  is  developed  may  be  gradually  directed  into  channels 
having  definite  aim  and  producing  daily  results  that  encourage  and 
sustain  effort.  It  is  to  this  form  of  prevention  that  the  attention  of 
the  public  is  already  directed,  and  the  methods  founded  upon  expe- 


TRAINING   AND   TREATMENT.  I  59 

rience  and  formulated  in  the  training  of  mental  defectives  are  those 
now  being  adopted,  with  modifications  of  course,  in  the  classes  rap- 
idly becoming  recognized  as  a  necessity  in  the  large  cities  of  both 
England  and  America.  For  it  is  generally  admitted  that  for  the 
backward  or  feebly-gifted  on  the  border  line  of  deterioration,  which 
either  undue  stimulation  or  lack  of  proper  emulation  is  sure  to 
precipitate,  a  special  training  is  absolutely  essential. 

Protection  from  "  cram,"  that  crying  evil  of  the  schools,  means 
for  many,  prevention  of  defect.  The  opportunity  therefore  to  de- 
velop slowly,  to  experiment,  to  test  means  and  finally  to  select  ave- 
nues best  adapted  for  advance,  may  so  develop  and  strengthen  dor- 
mant qualities  as  to  lay  the  foundation  of  character  insuring  useful- 
ness and  success  in  a  chosen  vocation. 

If,  on  the  other  hand,  weakness  be  found  degenerating  into  defect 
unfitting  the  individual  for  an  independent  existence,  special  training 
is  then  imperatively  needed  to  arrest  deterioration  and  to  prepare  the 
way  for  congenial  employment  and  consequent  happiness  in  com- 
munity life. 

Active  sports  are  to  be  encouraged,  not  only  as  being  simple, 
natural  and  healthful,  but,  for  the  defective,  absolutely  essen- 
tial. Feeble  circulation  is  for  him  the  baneful  author  of  many 
ills,  as  malnutrition  of  muscle,  of  brain  cells  and  nerve  tissue  is  sure 
to  bring  about  incoordination,  chorea  and  general  stupor  affecting 
all  the  faculties.  No  matter  what  the  quantity  of  food  taken  into 
the  system,  if  it  is  not  properly  distributed,  that  part  that  fails  to 
receive  nourishment  starves.  For  this  reason  the  blood  must  be 
sent  on  its  errand  of  supply  and  its  most  efficient  motor  is  pleasurable 
emotion.  The  effect  of  dancing  is  one  of  the  best  exponents  of  this 
theory,  and  is  an  amusement  in  which  most  children  delight,  and 
many  excel.  Entire  relaxation  after  occupation  or  drill  should  be 
encouraged  by  free  sports  and  games;  running,  racing,  swinging, 
leaping,  vaulting,  quoits,  tennis,  croquet,  etc.,  in  all  of  which  many 
soon  become  expert.  Foot-ball,  basket-ball,  and  base-ball  matches 
are  as  sharply  contested,  and  watched  and  discussed  with  as  much 
interest  as  is  any  game  of  professionals,  children  of  even  low  grade 
often  being  able  to  give  points  of  a  game  and  to  keep  or  at  least 
follow  a  score. 


l60  TRAINING   AND   TREATMENT. 

Although    free    play    and    active    amusements    have    their    place 
in    promoting    healthy    circulation    and    consequent    growth,    we 
must    not    lose    sight    of   the  fact    that    any    positive    defect,    de- 
formity or  awkwardness  may  soon,  if  persisted  in,  become  habit- 
ual.    This  may  be  checked  and  corrected  only  by  special  training 
in  exercises  adapted  to  peculiar  needs ;  such  tendencies  even  during 
play  hours  being  kept  under  restraint,  lest  indulgence  neutralize 
efforts  for  improvement.     The  dragging  footstep  so  characteristic 
of  the  imbecile,  which  when  coupled  with  the  droop  of  the  whole 
figure  amounts  in  the  lower  grades  to  a  shuffle  or  often  to  a  mere 
lurching  forward,  should  early  receive  attention.     Timed  races  down 
hill  and  counted  strides  up,  lending  exhilaration  and  stimulation, 
may  aid  the  walking  contests,  which,  in  the  school-room,  should 
break   the   tension   of   occupation   periods,    each    stepping   in   turn 
briskly,  yet  noiselessly,  up  and  down  the  room.     Stooping  may  be 
corrected  at  the  same  time  by  balancing  a  book,  a  basket,  or  any 
light  object  on  the  head.     Not  only  will  this  be  found  to  be  a  cor- 
rective of  bad  habits,  but  experience  has  proved  it  also  a  means  of 
acquiring  both  poise  and  ease.     Guided  to  a  kindly  criticism  of  one 
another  and  inspired  by  a  generous  emulation,  children  soon  learn 
to  recognize  defects ;  when  various  free  calisthenic  exercises  may 
suggest  themselves  and  be  added  as  additional  aids.     Light  ladders 
so  constructed  that  they  may  be  raised  and  lowered  at  will  are  valu- 
able adjuncts  to  school-rooms  or  play  grounds.    Placed  upright  and 
gradually  approaching  the  perpendicular,  they  will  bring  all  the  mus- 
cles into  play  and  also  promote  grasp  power.     Placed  horizontally 
on  the  floor,  many  errors  of  gait  may  be  corrected  by  stepping  be- 
tween the  rounds ;  confidence  may  be  stimulated  by  emulation,  and 
precision  by  clapping,  singing,  counting,  or  even  by  the  tap  of  a 
drum.     Somewhat  similar  results  are  attained  by  stepping  on  bricks 
placed  at  regular  distances,  but  this  exercise  tends  to  develop  more 
the  ankle  and  hip- joint,  whereas  the  other  necessitates  the  much- 
needed  bend  of  the  knee.     Similarly  arm-swinging  at  the  blackj 
board  will  promote  muscular  coordination,  and  should  precede  the 
ambidextrous  drawing  drill,  itself  a  most  efficient  agent  in  simul- 
taneous physical  and  mental  development,  the  two  drills  mutually 
aiding  and  testing  one  another.     Any  of  these  simple  exercises  in 


TRAINING   AND   TREATMENT.  l6l 

the  school-room,  practiced  for  a  few  minutes  daily,  and  con- 
ducted by  a  teacher  who  is  able  to  vary  and  adapt  them,  will  not  only 
go  far  to  correct  bad  habits,  but  will  prepare  the  child  to  enter  intel- 
ligently upon  the  regular  physical  training  drills  and  the  work  of 
the  gymnasium.  These  should  be  given  only  by  an  expert,  and  the 
children  should  learn  to  recognize  in  them  a  means  to  a  definite  end. 
In  fact,  they  often  do  gauge  themselves  and  one  another  by  the  test 
of  physical  power ;  as  one  boy  puts  it,  "  I  must  know  a  good  bit,  for 
I'm  getting  strong." 

Physical  training,  in  its  threefold  aim  of  curing  defect,  building 
up  strength,  and  increasing  power,  includes  both  treatment  and  train- 
ing; for  frequent  baths  and  massage  must  cleanse  the  skin,  excite 
the  secretions,  arouse  functional  activity,  and  bring  the  whole  body 
into  readiness  for  the  struggle  to  secure,  through  constant  and  per- 
sistent movements,  that  proper  respiration,  circulation,  and  coordi- 
nation so  essential  to  the  perfect  physique,  and  so  lacking  in  the 
defective.  Here  the  advance  from  simple  to  complex — that  under- 
lying law  of  all  education — must  know  no  variation ;  there  must  be 
no  hiatus  and  no  strain  in  the  process,  if  the  result  is  to  be  a  frame 
well  knit,  of  good  balance,  with  muscles  perfectly  subordinated  to  the 
will.  To  this  end  the  Swedish  Ling  system  is  especially  adapted. 
By  this  method  each  and  every  part  of  the  body  is  exercised  suc- 
cessively by  a  well-graded  series  of  movements.  When  these  can 
be  executed  in  response  to  command,  then  the  drills  with  music  fol- 
low ;  these  combining  rhythmic  grace  with  close  attention  and  obe- 
dience to  suggestion  are,  as  being  more  intellectual,  better  adapted 
to  a  growing  intelligence. 

Building  upon  these  conditions  for  additional  results  come 
military  drills,  the  educational  value  of  which,  for  the  defective, 
is  being  generally  recognized.  Here  in  the  united  action  of  close 
rank  and  file,  the  relation  of  the  individual  to  the  community  is 
sharply  defined.  The  boy  finds  his  level  at  the  outset;  learns  that 
he  must  attain  in  "  squad  work  "  a  certain  standard  of  precision, 
attention  and  readiness  of  movement  before  he  is  permitted 
to  "  shoulder  "  or  "  present  arms  "  with  his  comrades,  who  in  "  suc- 
cessive work "  have  already  entered  upon  smoothness,  accuracy, 
and  reliability  of  movement;  lest  any  failure  of  his  affect  the  order 
ii 


1 62  TRAINING   AND   TREATMENT. 

of  the  whole.  Thus  the  uniform  comes  to  be  to  him  not  a  mere 
matter  of  "  buttons,"  but  a  type  of  that  genuine  uniformity  of  good 
bearing,  of  movement,  of  prompt  action  and  of  courtesy  which  goes 
to  build  up  a  good  member  of  any  company,  be  it  as  soldier  or 
craftsman.  Indeed  we  are  able  to  trace  much  character  building  to 
just  such  training,  which  one  can  no  more  afford  to  dispense  with 
in  a  training  school  or  in  a  colony,  than  in  a  garrison,  for  it  is  needed 
not  only  to  vitalize,  but  to  sustain  enfeebled  forces.  Self-control 
and  the  power  to  arrest — that  safeguard  against  catastrophe — is  the 
chief  moral  gain  acquired  by  the  "  setting-up  exercises,"  which  bring 
the  entire  muscular  system  into  coordinated  action,  at  the  same  time 
promoting  deep  and  proper  breathing  and  the  full  and  correct  use 
of  the  respiratory  organs.  It  has  been  computed  that  from  four  to 
seven  times  as  much  oxygen  is  taken  into  the  lungs  during  these 
exercises  as  during  a  corresponding  period  of  repose,  and  this  per- 
fect oxygenation,  vitalizing  all  the  organs,  insures  normal  function- 
ing and  consequent  elimination  of  the  effects  of  wear  and  tear. 

If  such  be  the  effects,  mental,  moral,  and  physical  of  this  training, 
it  is  apparent  at  once  why  these  movements  should  form  part  of  the 
daily  school  program,  until  sluggishness  yields  to  habit  and  response 
to  command  becomes  intuitive  and  voluntary. 

But,  in  addition  to  the  awakening  and  energizing  effect  of  the 
drills,  the  apparatus  of  a  well-appointed  gymnasium  is  needed  to 
strengthen  and  to  build  up  the  system  and  to  correct  defect.  The 
use  of  the  spring  board,  for  example,  supplementing  the  walking 
drills,  encourages  the  dragging  step  to  gain  elasticity;  the  swinging 
of  clubs  and  dumbbells  induces  free  coordinated  action  as  well  as 
concerted  movement  and  repose.  This  last,  as  the  very  initial  of 
power,  should  mark  every  step  in  this  most  important  training ;  the 
relaxing  into  a  state  of  passivity,  the  starting  into  action,  and  the 
return,  each  constituting  a  separate  act  of  the  will,  for  it  is  the  lack 
of  ability  to  recognize  and  to  do  these  things  that  characterizes  the 
great  mass  of  incapables. 

Of  equal  importance  with  the  training  in  muscular  coordination 
is  the  training  for  grasp  power.  Indeed,  were  we  to  class  the 
muscular  as  a  sixth  sense,  we  might,  with  even  greater  show  of 
reason,  recognize  the  prehensile  as  the  seventh  sense,  for  although 


TRAINING   AND   TREATMENT.  1 63 

it  combines  the  tactile  and  the  muscular,  it  yet  is  neither  the  one  nor 
the  other.  Viewing  the  close  relation  existing  between  physical 
and  mental  potentialities,  one  might  almost  call  this  their  meeting- 
ground  ;  so  close  do  they  come,  in  fact,  that  the  same  terms  are  used 
to  express  action  in  both.  Thus  in  the  culmination  of  physical  or 
of  mental  effort  we  grasp  or  lay  hold  of — either  with  the  hand  or 
with  the  mind.  Take,  for  the  sake  of  illustration,  one  whose  fingers 
have  been  amputated.  He  has  not  only  lost  hand-power,  but  his 
whole  thinking  apparatus,  so  to  speak,  must  be  readjusted;  he  can 
no  longer  grasp  or  take  hold  of  as  he  once  did;  he  must  arrive  at 
conclusions  in  some  other  way  that  must  be  laboriously  sought  and 
can  be  found  only  through  painful  experience.  His  loss  is  not  only 
physical,  but  mental  as  well,  and  means  for  him  a  new  education,  or 
at  least  involved  mental  processes.  Now  if  this  be  true  of  one 
suddenly  deprived  of  this  sense  avenue — for  I  contend  it  is  a  real 
avenue  and  not  a  mere  figure  of  speech — may  it  not  serve  to  reveal 
the  mental  condition  of  one  who  has  not  known  its  benefits  ?  Those 
weak,  nerveless  fingers  of  the  untrained  imbecile,  which  can  lay 
hold  of  nothing  and  retain  nothing  within  their  grasp,  and  the  ner- 
vous clutch,  unconscious  of  its  violence,  are  equally  expressive  of, 
as  they  are  linked  inseparably  with,  mental  incapacity.  To  modify 
this  disability  and  to  strengthen  what  remains  is  the  summum  bonum 
of  our  endeavor — the  beginning  and  the  end  of  training. 

In  the  simplest  operations  of  sense  awakening  in  the  idiot,  as  in 
the  systematized  work  of  the  kindergarten,  in  the  industrial  occupa- 
tions— varying  from  simple  to  complex  to  suit  capacity — in  the  man- 
ual arts,  from  the  simplest  tool  that  merely  punches  a  hole,  to  the 
wielding  of  hammer,  saw,  or  chisel,  on  to  the  finer  cultivation  of 
finger-clasp  of  pen  or  pencil,  needle  or  brush,  this  single  aim  of 
gaining  grasp-power  may  be  traced.  This  attained  in  its  fullness, 
all  other  power  is  included.  In  fact  as  an  indication  of  capacity 
the  grasp-power  is  superior  even  to  the  language  test  for  which  so 
much  is  claimed.  For,  be  it  remembered,  the  jdio-imbecile  who  can 
wash  a  dish,  clutch  a  cloth,  handle  a  broom,  or  lift  a  child  may  yet 
have  no  greater  power  of  articulate  speech  than  the  idiot  he  carries. 
The  imbecile  of  low  grade  may  be  quite  as  mute  as  he,  or  may  only 
chatter  like  a  magpie.     Yet  he  does  all  these  things  as  well  or  bet- 


164  TRAINING   AND   TREATMENT. 

ter,  and,  moreover,  can  handle  with  ease  the  heavy  utensils  of  the 
kitchen,  add  coal  to  the  fire,  can  guide  a  horse,  hoe  a  garden-bed, 
or  pick  vegetables;  here,  too,  we  meet  variations  of  physical  grasp 
associated  with  perceptible  advance  in  mentality,  for  he  can  hold 
needles  and  count  stitches,  setting  up  and  taking  off  work,  can  wind, 
plait,  weave,  and  accomplish  a  variety  of  finger  movements  while 
still  supporting  or  grasping  his  work. 

To  follow  the  middle  grade  in  the  development  of  this  same  sense, 
we  find  that  he  displays  greater  intelligence  in  the  performance  of 
all  these  tasks ;  a  fuller  mental  grasp  of  situations,  coupled  with  both 
physical  and  -mental  capacity  for  doing  more.  A  grasp  upon  tools 
and  a  knowledge  of  their  uses  make  him  a  capable  worker  in  the 
various  handicrafts ;  he  can,  in  fact,  make  and  carve  furniture  or 
help  to  build  a  house.  The  power  of  oral  expression  may  or  may  not 
be  materially  increased  by  training ;  he  may  or  may  not  learn  to  read, 
but  grasp-power  registers  for  him  a  distinctly  higher  plane  of  intel- 
ligence. 

In  the  high-grade  we  find  a  perceptible  relaxing  on  one  hand  as 
he  reaches  out  on  the  other ;  he  can  do  almost  anything,  but  probably 
does  not  make  so  good  a  "  man  with  the  hoe,"  because  of  distinctly 
marked  proclivities  in  more  abstract  and  consequently  more  intel- 
lectual directions.  Tools  he  can  use,  accomplishing  finer  and  more 
difficult  work ;  but  he  can  also  clasp  and  use  pen  and  pencil  with  a 
purpose  as  clear  as  he  brings  to  his  type-setting  or  to  finger 
pressure  upon  organ,  piano,  or  violin.  Thus  through  slow  grada- 
tions, with  regular  "  stop-off  "  as  limit  is  reached,  does  the  hand 
alternately  lead  and  follow  mental  development. 

In  its  effort  at  all  round  development,  training  is  constantly  ap- 
pealing to  the  moral  and  ethical  sense ;  neither  encouragement,  disci- 
pline, nor  religious  influences  are  lacking;  yet  we  may  not  hope  for 
the  attainment  of  more  than  a  child's  standard  of  right  and  wrong. 
One  who  speaks  as  a  child,  thinks  as  a  child,  and  understands  as 
a  child,  can  never,  even  if  arrived  at  years  of  discretion,  put  away 
childish  things,  and  should  never  be  judged  according  to  adult 
standard,  and  we  who  know  that  these,  apparent  men  and  women 
are  so  in  years  only,  never  look  for  a  greater  degree  of  responsi- 
bility or  of  spirituality  than  is  to  be  found  in  the  ordinary  boy  or 


Plate   XXVIII. 


TRAINING   AND   TREATMENT.  1 65 

girl.  Nevertheless  the  perpetual  aim  of  guardianship,  as  of  train- 
ing, is  to  maintain  this  standard  and  never  to  tolerate  the  excuse 
sometimes  given :  "  How  could  I  know  I  was  wrong  if  I  am  feeble- 
minded ?  "  They  do  know  right  from  wrong  and  are  quick  to  report 
wrong  in  another ;  and  in  the  way  they  know,  and  just  so  far  as  they 
know,  should  they  be  held  firmly  accountable.  At  the  same  time  it 
must  be  remembered  that  they  receive  only  in  childish  fashion  moral 
and  religious  truths  to  which,  from  force  of  environment,  imitation, 
habit,  and  largely  because  of  protection  from  temptation,  they  in  a 
general  way  conform.  Thus  they  have  a  child's  idea  of  an  over- 
ruling Providence  and  of  the  Gospel  story;  they  repeat  prayers  and 
sing  with  delight  the  hymns  and  carols  of  the  seasons ;  they  are 
decorous,  giving  at  least  an  outward  show  of  reverence,  during  the 
religious  offices,  yet  they  are  incapable  of  deep  convictions,  or  of 
reasoning  out  a  truth.  To  a  large  number  the  great  evil  in  lying 
and  stealing  is  the  being  found  out  and  punished.  Will  many  nor- 
mal children,  however,  go  further  than  this? 

The  disadvantage  for  the  feeble-minded  out  in  the  world,  or  in  the 
family,  is  that  there  is  either  too  little  or  too  much  expected  of  them ; 
they  must  be  required  to  stand  up,  but  they  cannot  stand  entirely 
alone.  Like  all  children,  they  need  and  must  have  a  certain  moral 
and  sustaining  brace  to  hold  them  up  to  a  standard,  and  this  they 
can  get  only  from  those  who  understand  them  and  who  know  how 
to  deal  with  them,  and  by  association  and  comparison  with  their  own 
kind. 

As  aids  indispensable  in  the  training  of  feeble  minds,  we  have 
classed  Environment,  Association,  Amusement,  and  Discipline  in 
their  four-fold  influences  one  might  almost  say ;  for  they  combine  to 
quadruple  one  another,  and  all  are  needed,  nor  can  we  afford  to  lose 
one  element  of  our  motor  power. 

The  environment  specially  adapted  to  this  work  is  one  that  will 
lend  variety,  and  help  to  stimulate  and  develop.  True,  earnest 
work  may  be  done  anywhere  and  succeed  in  the  face  of  many  diffi- 
culties, but  in  the  choice  of  location,  one  should  be  influenced  by 
considerations,  moral  and  esthetic,  as  well  as  by  those  of  convenience 
and  hygiene.  For  a  life  in  the  open  air,  and  to  induce  healthful  ex- 
ercise, valley  and  upland,  running  streams,  groves  and  open  sunlit 


1 66  TRAINING   AND   TREATMENT. 

spaces  are  necessary.  Windows  should  have  a  broad  outlook  and 
show  attractive  vistas,  for  earth  and  sky  and  water  are  as  pictures 
and  open  pages  in  the  hands  of  a  teacher  who  understands  the  mold- 
ing and  building  of  taste  and  character.  Guggenbiihl,  be  it  remem- 
bered, ascribed  not  a  little  of  his  success  in  sense  awakening  to  the 
wonders  of  Alpine  scenery  and  the  panorama  outspread  before  the 
dwellers  upon  the  Abendberg. 

If  attractive  interiors  with  decorations  varied  with  the  season,  be 
of  use  in  awakening  the  dulled  senses  of  the  idiot,  of  how  much 
greater  value  is  such  an  agent  here,  where  not  only  are  the  senses 
to  be  kept  aroused,  but  the  grosser  instincts  are  to  be  held  in  abey- 
ance and  dulled,  by  cultivating  the  refined.  Thus  the  aspect  that 
dining-rooms,  dormitories  and  school-rooms  present;  the  character 
of  music  and  amusements ;  the  selection  of  books  and  pictures,  which 
are  a  part  of  life ;  the  matter  of  association  in  grades ;  the  manner  and 
bearing  of  those  who  come  into  daily  intercourse  with  the  children ; 
all,  in  fact,  that  pertains  to  the  manner  of  living,  are  inseparably 
mingled,  and  combine  to  form  an  environment  constituting  atmos- 
phere, not  one  element  of  which  may  be  deemed  unimportant ;  for  the 
defective,  even  more  than  the  normal,  needs  that  "  outer  "  which 
Froebel  shows  "  ever  conditions  the  inner." 

A  question  often  asked  is,  What  is  the  effect  of  associa- 
tion upon  this  class?  The  weak  will,  naturally,  is  subordinated 
to  the  stronger ;  and  where  there  is  admiration,  imitation  follows  even 
more  naturally.  Thus  the  character  and  deportment  of  those 
brought  into  daily  and  immediate  contact  with  the  children  are  fac- 
tors in  training,  so  essential  as  to  necessitate  great  care  in  selection ; 
the  results  in  general  tone,  gained  from  refined  association,  will  be- 
come noticeable  even  among  younger  children  of  the  lower  grades. 
In  illustration  of  this:  an  attendant  newly  entered,  and  not  quite 
up  to  mark,  was  noted  passing  repeatedly  without  necessity  and  with- 
out apology  in  front  of  the  officer  in  charge  of  the  children's  dining- 
room,  evidently  utterly  unconscious  of  any  discourtesy;  yet  a  boy 
of  low-grade,  in  his  duties  of  serving,  passed  instinctively  with  bowed 
head  and  a  low-voiced  "  excuse  me."  His  was  not  an  individual, 
but  a  typical  case;  a  little  thing  one  might  say,  but  an  exposition 
of  the  training  his  group  had  received.     As  to  the  association  of 


TRAINING  AND   TREATMENT.  1 67 

mental  defectives  with  one  another,  our  whole  argument  has  been 
for  congregate  over  solitary  training,  because  the  child  is  always  best 
among  his  peers,  and  this  grouping  according  to  grades  of  intelli- 
gence, is  a  classification  arranged  not  only  for  the  school-room,  but 
it  extends  throughout  the  daily  living  experience,  in  the  clubs  for 
boys,  in  the  circles  for  girls,  in  dormitories,  dining-rooms,  and  play- 
rooms. Such  association  corresponds  largely  to  that  of  members  of 
a  large  family,  or  seeks  at  least  as  much  as  is  secured  in  many  schools 
for  normal  children,  by  the  arrangement  of  separate  forms  for  chil- 
dren of  similar  age  and  capacity;  needing  always  of  course,  that 
oversight  that  would  detect  and  remove  immediately  any  case  of 
moral  obliquity  that  might  endanger  the  well-being  of  the  whole. 
Under  these  conditions,  general  association  has  proved  not  disad- 
vantageous, for  an  imbecile  would  be  no  more  influenced  by  an  idiot 
than  would  a  normal  child  by  a  baby  of  the  household,  although  the 
idiot  might  gain  somewhat,  just  as  the  infant  might.  Indeed,  a  per- 
petual childhood  creates  a  certain  kinship,  and  the  relationship  of 
grades  is  somewhat  similar  to  that  of  younger  and  older  members 
of  one  family.  This  is  evidenced  in  institutions,  in  the  care  bestowed 
by  boys  upon  epileptics  and  cripples,  and  in  the  girls,  whose  tender- 
ness for  some  little  weakling  betrays  the  unconscious  maternal  in- 
stinct, coupled  with  all  the  simplicity  of  a  child  over  its  doll.  Nev- 
ertheless, clearly  and  for  definite  reasons,  the  classification  does  not 
permit  close  companionship  of  different  forms  of  defect,  but  calls 
for  separation,  that  each  may  go  to  his  own  and  avoid  even  the  pos- 
sibility of  absorption. 

Amusement,  a  preponderating  element  in  education,  and  coming 
to  be  regarded  more  and  more  as  a  much  needed  relief  to  high 
pressure,  has  always  been  a  recognized  agent  in  training  feeble 
minds  and  bodies ;  where  rest,  including  exercise,  has  had  to  follow 
effort,  and  diversion  to  succeed  occupation  in  one  unvarying  round, 
lest  overstrain  should  bring  about  sudden  collapse.  Possessing,  there- 
fore, both  an  educational  and  a  therapeutic  value,  its  providing,  de- 
vising and  distributing  forms  no  unimportant  part  in  the  work  of 
direction,  in  order  that  it  may  be  so  apportioned  as  to  meet  the  needs 
of  all  and  fulfill  its  aim  of  recuperation  without  degenerating 
into  the  weakness  of  dissipation.     In  addition  to  the  periods  of  free 


1 68  TRAINING   AND   TREATMENT. 

play,  the  house  games  and  field  sports  of  the  daily  programs,  each 
season  brings  its  special  diversion,  realizing  pleasurable  anticipation 
and  inducing  self-control  for  fear  of  losing  the  coveted  birthday 
feast,  picnic  or  excursion. 

Still  more  specifically  educational  are  those  forms  of  entertain- 
ment that  bring  into  practical  play  the  specialties  of  the  school  train- 
ing; concerts — vocal  and  instrumental — operettas,  dramas,  dancing 
and  athletics.  Evenings  with  the  stereopticon  are  not  only  illustrative 
of  but  a  stimulus  to  the  study  of  plant  and  animal  life,  geography, 
history  and  current  events;  one  and  all  are  expected  to  contribute 
information  as  called  upon,  or,  on  the  other  hand,  the  members  of 
a  class  may  each  in  turn  be  required  to  explain  the  details  of  the 
pictures,  which,  on  occasion,  may  be  further  emphasized  in  song. 
In  this,  also,  as  in  the  theatrical  presentations,  the  principle  of  co- 
operation for  mutual  benefit,  as  well  as  the  social  obligation  to  others, 
is  enforced,  the  result  often  being  that  a  club  or  a  circle  offers  to 
contribute  to  or  to  assume  the  responsibility  of  some  one  entertain- 
ment during  the  year,  frequently  accomplished  without  assistance 
or  suggestion.  The  composing,  printing  and  distributing  of  pro- 
grams and  invitations ;  the  arrangement,  even  the  originating  of  cos- 
tumes, and  the  selection  and  rendering  of  music,  often  displaying 
not  a  little  ingenuity,  wit  and  humor  without  coarseness ;  and  these 
efforts  are  always  sure  of  winning  enthusiastic  applause  from  an 
appreciative  audience.  Those  who  undertake  these  entertainments 
are  simply  working  out  an  experience  gained  through  careful  train- 
ing in  the  preparations  and  rehearsals  of  the  plays  and  operettas 
which,  in  every  large  training-school,  mark  the  holiday  seasons. 
These,  while  satisfying  that  love  of  impersonation  and  "  dressing 
up  "  inherent  in  all  children,  supplement  the  work  of  the  school  in 
memory  training  and  general  culture,  and  give  a  stimulus  and  in- 
ducement to  redoubled  exertion,  as  well  as  to  the  maintenance  of 
good  records,  for  to  be  included  among  the  dramatis  persona  is  a 
much  coveted  pleasure  and  exclusion  is  accounted  a  severe  discipline. 
In  view  of  the  egotism  and  vanity  of  these  children  in  private  life 
seeking  always  to  be  in  evidence,  their  simplicity  and  unconscious- 
ness on  the  stage  betrays  their  intense  childishness.  They  become 
interested  in  the  play  as  in  a  pretty  game,  give  no  thought  to  the 


Plate  XXIX. 


5 


TRAINING   AND   TREATMENT.  1 69 

audience,  and  often  succeeding  under  circumstances  where  nor- 
mal children  might  fail,  they  render  with  accuracy  and  spirit 
such  operettas  as  Robin  Hood,  The  Chimes  of  Normandy,  The  Mas- 
cot, The  Four-leaf  Clover,  Dick  Whittington,  The  Pied  Piper,  and 
Columbus. 

The  tonic  effect  of  discipline  is  as  necessary  an  aid  in  the 
training  of  the  feeble-minded  as  is  the  stimulus  of  amusement. 
In  order  to  make  general  and  special  provision  to  meet  the  needs 
of  a  perpetual  childhood  as  well  as  of  peculiar  dispositions,  wide 
experience  is  required  in  the  character  of  grades,  and  a  thorough 
knowledge  of  special  nervous  conditions  is  essential.  In  this  as  in 
every  other  feature  of  training,  the  advantage  of  numbers  is  appa- 
rent. A  rule  to  which  the  many  are  subjected  becomes  a  matter  of 
course  to  the  one.  On  the  other  hand  the  defective  among  normal 
children  is  either  subject  to  no  rule,  and  losing  the  benefit  of  both 
discipline  and  emulation,  becomes  spoiled ;  or  else  being  the  only  one 
under  special  restraint,  he  resents  it  as  tyranny,  and  wilfully  or  ig- 
norantly  misunderstanding,  his  nerves  are  kept  in  a  continued  state 
of  tension. 

With  many  the  instinct  of  justice  is  strong;  they  recognize 
the  abiding  force  of  law,  will  yield  to  it  themselves  and  report 
any  infraction  of  it  in  others.  They  know  when  they  deserve  disci- 
pline, and,  if  given  in  the  right  spirit  and  by  the  proper  per- 
son, will  accept  it;  they  are,  however,  quick  to  detect  what  is  un- 
authorized, and  to  resent  what  savors  of  temper,  revenge,  or  injus- 
tice. Let  the  child  feel  that  the  command  is  given  because  it  is  right, 
and  he  soon  learns  that  the  highest  happiness  is  attained  through 
freedom  under  law.  Care  must,  however,  be  exercised  that  this 
growing  appreciation  be  not  crushed  by  a  hasty  judgment  of  mere 
acts.  If  the  occasion  must  be  met,  it  is  generally  found  best  to  make 
the  punishment  fit  the  offense.  Thus,  one  given  to  wandering  from 
his  seat  is  made  to  stand,  for  a  short  time,  where  he  is  found,  with  a 
book  on  his  head;  an  incessant  talker  may  have  the  reminder  of 
a  handkerchief  bound  lightly  across  his  lips ;  a  loiterer  at  recess  is 
placed  for  several  days  in  charge  of  a  comrade  who  is  to  bring  him 
in  promptly;  a  persistent  disturber  of  the  peace  is  set  aside  with 
a   paper   cap    drawn   over   his   head,    a    simple    effacement    for    a 


I70  TRAINING   AND   TREATMENT. 

short  period.  If  sullenness,  obstinacy,  or  carelessness  necessitates 
more  stringent  measures,  the  deprivation  of  some  luxury,  such  as 
sweets  or  an  amusement,  is  often  sufficient.  Bad  habits  may 
necessitate  entire  separation  from  companions  for  a  day  or  two  at 
hard  work,  or  isolation  in  a  quiet  room,  always,  however,  with  some- 
thing to  occupy  the  mind — books,  pictures,  toys,  games,  or  work. 
The  most  severe  punishment  that  could  be  meted  out  to  one  boy  was 
to  cut  a  button  off  his  coat ;  to  another,  to  deprive  him  of  coffee,  of 
which  he  was  exceedingly  fond;  to  another — that  usually  accorded 
persistent  runaways — the  wearing  of  a  dress.  These  last,  the 
victims  of  a  veritable  " wanderlust"  are  more  to  be  pitied  than 
blamed,  for  the  impulse  amounting  almost  to  insanity  is  al- 
most as  uncontrollable.  Only  in  very  exceptional  cases,  where  the 
child  unusually  refractory  is  in  full  health,  may  the  deprivation  of 
food  be  permissible.  All  too  often  may  defective  conditions  be 
traced  to  malnutrition  at  some  remote  period,  so  that  reduction  of 
diet  as  a  mode  of  punishment  is  not  to  be  advocated.  On  the  other 
hand,  a  change  of  diet  becomes  a  necessity  in  cases  where  naughti- 
ness, so  called,  is  in  reality  physical  disability.  The  child  is  ill, 
its  nerves  worn  to  a  thread,  and  examination  will  reveal  a 
furred  tongue,  foul  breath,  and  tears  very  near  the  surface ;  so 
miserable  in  fact  that  it  must  give  expression  to  its  feelings,  and 
"  naughtiness  "  is  the  result.  A  cathartic — small  doses  of  calomel 
or  salts — instituting,  as  it  were,  a  physiologic  house-cleaning,  a 
day  or  two  in  bed,  a  diet  of  bread  and  milk — hot  in  winter  and  cold 
in  summer — will  work  wonders,  morally  as  well  as  physically.  Sta- 
tistics show  that  10  ounces  of  bread  and  1  pint  of  skimmed  milk, 
equal  in  nutriment  a  diet  composed  of  8  ounces  of  soup,  2  ounces 
of  beef,  2  ounces  of  potatoes,  1  ounce  of  turnips,  4  ounces  of  bread, 
Yz  ounce  of  butter,  and  1  cup  of  coffee  containing  1  ounce  of  new 
milk  and  ^2  ounce  of  sugar. 

We  are  too  often  prone  to  judge  a  defective  child  by  our  own 
standards,  forgetting  that  his  are  very  vague  and  in  matters  of  truth 
and  honesty  often  absolutely  wanting.  The  boy  who  will  lie  un- 
blushingly,  or  surrender  a  stolen  article  from  his  pocket  without 
confusion,  has  not  yet  reached  a  plane  to  comprehend  "  preachments." 


TRAINING   AND   TREATMENT.  I7I 

Much  may  be  done  in  the  way  of  prevention  by  healthful  emula- 
tion and  the  offer  of  simple  rewards  open  to  all ;  such  as  good  con- 
duct tokens,  an  honor-medal  or  trinket,  a  simple  school-treat  or  ex- 
cursion, or  even  the  privilege  of  better  material  for  good  workers. 

A  plan  that  has  worked  well  with  the  brighter  girls  was  suggested 
by  a  friend  who  gave  for  the  purpose  a  silver  bracelet,  the  enameled 
clasp  bearing  the  legend  "  Study  to  be  quiet."  This  won  as  a  re- 
ward for  well-doing  was  worn  for  a  week,  but  withdrawn  upon  dere- 
liction of  duty. 

An  outward  and  visible  sign  of  approbation  means  a  great  deal  to 
defective  children,  and  the  effort  to  attain  it  or  even  to  win  a  word 
of  commendation  will  often  effect  a  diversion  and  clear  the  atmos- 
phere for  the  day.  To  be  sure  there  are  all  kinds  of  nervous  tem- 
peraments acting  and  reacting  one  upon  another,  and  bad  habits  and 
exaggerated  impulses  require  sharp  bracing  up  from  time  to  time. 
No  one  recognizes  this  more  fully  than  do  the  children  themselves ; 
just  as  a  boy  seated  one  day  at  my  office  door,  to  the  inquiry,  "  Why 
are  you  here  ?"  replied :  "  Me  bad  boy,  Doctor  make  me  good," 
coupled  with  a  very  suggestive  patting  of  the  hands :  and  the  Doc- 
tor did,  and  in  a  few  minutes  he  was  happy  with  his  boys  going 
out  to  dinner. 

On  the  subject  of  corporal  punishment,  there  is  a  great  divergence 
of  opinion.  Down  contends  that  it  should  be  strictly  forbidden. 
Shuttleworth  says :  "  Corporal  punishment  is  rarely  beneficial ;  yet 
there  are  cases  where  pain  wantonly  inflicted  on  others  is  appropri- 
ately visited  by  pain  inflicted  on  the  offender."  My  experience  is 
that  there  are  occasions  calling  for  heroic  treatment  when  nothing 
but  corporal  punishment  will  avail.  A  few  light  taps  in  the  gluteal 
region  with  a  paddle,  hair  brush,  or  a  slipper,  will  often  be  sufficient 
to  bring  a  sense  of  physical  restraining  force  which  the  child  really 
needs  and  unconsciously  craves.  '  Some  years  ago,  on  a  Christmas 
morning,  a  boy  enraged  with  a  comrade  made  a  sudden  and  unpro- 
voked attack  upon  him  and  blacked  both  his  eyes  before  the  attend- 
ant could  interfere.  After  the  spanking — which  he  acknowledged  he 
richly  deserved — we  shook  hands  and  parted  the  best  of  friends.  At 
dinner  he  was  the  merriest  at  his  table — where  twelve  boys  disposed 
of  five  turkeys.    He  took  part  in  a  play  in  the  afternoon,  and  gay  and 


172  TRAINING   AND   TREATMENT. 

light-hearted  danced  the  evening  away.  Meeting  me  on  the  way  to 
the  dormitories,  he  threw  his  arms  impulsively  around  me,  exclaim- 
ing :  "  It  has  been  such  a  happy  day.  I  know  I  deserved  punishment, 
but  if  you  had  locked  me  up,  or  put  me  to  bed,  I  never  should  have 
forgiven  you."  This  was  by  no  means  the  last  of  our  encounters,  but 
as  before,  we  regularly  parted  good  friends.  Another  incident  not 
to  be  forgotten,  transpired  a  few  months  later.  I  had  told  him  that 
it  was  better  to  think  twice  before  speaking,  and  one  morning  he 
came  to  make  a  confession.  A  boy  had  called  him  an  ugly  name, 
"  And  you  know,"  he  said,  "  you  told  me  to  think  twice  before  speak- 
ing, so  I  kept  quiet  and  did  not  say  anything."  Upon  my  congratu- 
lating him,  he  hung  his  head  and  replied :  "  Yes — but — I  blacked 
his  eye  for  him."  He  was  subject  to  delusions,  and  confided  to  me 
on  one  occasion,  that  the  reason  he  was  so  good,  was  because  he  had 
had  precisely  sixty  spankings  in  early  childhood. 

Not  infrequently  a  child  will  suggest  its  own  punishment,  as  in 
the  case  of  a  boy  persistently  unclean.  All  milder  forms  of  cor- 
rection, such  as  light  diet,  bed,  loss  of  dessert,  etc.,  had  been 
tried  without  effect.  Finally  one  day  he  exclaimed :  "  I  won't  be 
good  until  I'm  spanked.  My  mamma  always  spanked  me  for  this, 
and  it  does  me  good."  He  was  right,  for  two  light  spankings  proved 
effectual.  Another  boy  having  the  same  habit  responded  to  like 
treatment,  and  for  over  three  years  gave  no  trouble.  A  high-grade 
boy  of  19  had  committed  a  fault  that,  although  clearly  proven,  he 
would  not  acknowledge.  Every  effort  was  made  to  gain  the  con- 
fidence which  he  doggedly  refused.  Separated  from  his  compan- 
ions, placed  on  low  diet,  exercising  only  with  an  attendant,  still  he 
was  defiant.  Finally  driven  to  the  last  resort,  I  spanked  him,  and 
the  second  light  stroke  of  the  hair-brush  brought  a  flood  of  tears  and 
the  confession,  as  he  sobbed  out :  "  Doctor,  why  didn't  you  spank 
me  long  ago  ?  "  Now  and  again  when  I  meet  him,  he  felicitates 
himself  with :    "  I  tell  you  that  spanking  did  me  good." 

Said  a  good  magistrate  in  a  neighboring  city :  "  If  parents  would 
attend  to  their  duty  and  punish  as  the  good  Lord  has  taught  they 
should,  there  would  be  no  need  of  juvenile  courts.  Because  one 
father  is  a  brute,  there  is  no  reason  for  ten  others  to  be  fools  and 
hand  their  children  over  to  the  law  for  correction."     Yes,  that  is  it ! 


Plate  XXX. 


TRAINING   AND   TREATMENT.  I  73 

Sentimentality  and  "  gush  "  take  the  place  of  true  sentiment  and 
common  sense,  and  the  children  are  the  victims. 

The  following  abstract,  taken  from  an  educational  journal,  will 
best  emphasize  the  good  man's  excellent  theory — well  proven  in 
my  own  experience :  "  I  know  a  teacher  who,  priding  herself  on 
'  no  corporal  punishment,'  says  she  has  found  it  works  a  great  deal 
better  and  takes  hold  of  the  child  a  great  deal  better  if  she  holds  her 
punishments  over  the  child  for  twenty-four  hours. 

"  It  is  her  custom  to  say  to  the  child,  '  I  am  too  busy  to  decide 
what  to  do  with  you  to-night ;  but  come  to-morrow  morning  ready 
for  your  punishment.'  This,  plus  a  day  of  '  freezing  the  child,'  as 
she  called  it,  usually  subdues  even  the  most  troublesome. 

"  There  is  no  doubt  but  that  the  child  is  subdued.  During  all 
those  hours  that  intervene  between  the  teacher's  threat  and  the  prom- 
ised punishment,  the  child's  mind  has.  been  sending  its  depressing 
thought-waves  along  the  nerve-wires  to  the  emotional  centers ;  thus 
the  physical  vitality  has  become  impaired,  and  the  child  is  subdued, 
just  as  anyone  would  be  under  the  nervous  dread  of  an  impending 
evil.  If  such  refinement  of  brutality  is  to  be  the  substitute  for  the 
old-time  (  rattan,'  let  us,  a  thousand  times  better,  have  it  back,  the 
time-honored  rattan;  give  the  child  the  old-time  five  blows  on  the 
hand,  and  send  him  out  at  recess  to  forget  all  about  it  in  his  play. 

"  Any  course  of  discipline  that  plays  upon  the  sensitive  vital  cen- 
ters of  a  child's  nervous  organism,  is  criminal.  Fear  and  dread 
depress  the  heart-centers ;  they  lower  circulation  and  respiration ; 
and  for  any  teacher  who  would  thus  offend  one  of  these  little  ones 
it  were  better  for  her  that  a  millstone  were  around  her  neck."1 

An   illustration   of    the    practical    application    of   principles    and 

methods  discussed,  may  be  found  in  the  following  outline  of  a  day's 

work. 

SCHEDULE. 

Kindergartens  a  b  c. 
For  Little  Children  of  Low,  Middle  and  High  Grade,  to  be  Modified 

According  to  Mental  Capacity. 
A.  M. 

9.00.     Morning  talk  and  songs. 

9.30.     Dictation  with  gifts,  and  reproduction. 
10.15.     Recess;  all  reassembling  for  marching,  games,  and  songs. 

xThe  Child's  Emotional  Centres,  by  Mara  L.  Pratt,  M.D.  Child-Study 
Monthly,  February,  1896. 


174 


TRAINING   AND   TREATMENT. 


II.I5- 
II.30. 
12.00. 
P.  M. 
2.00 

to 
4.00. 


4.00 
to 

5.00. 
7.00. 

A.  M. 
9.00. 

9-I5- 
9.30. 

10.00. 

10.40. 
11.00. 
12.00. 

P.  M. 
2.00. 

2.30 

to 

4.00. 


4.00 

to 

5.00. 
7.00 

to 
8.00. 

A.  M. 
9.00. 

9- IS- 

10.30. 
11.00. 
11.30. 


Lessons  in  exercising  the  senses. 

Object-lesson. 

Closing  song. 

Occupations  alternating  with  songs  and  calisthenics,  or  clay-model- 
ing, drawing,  and  primary  lessons  in  reading  and  numbers  at  black- 
boards. These  exercises  to  be  supplemented  and  aided  by  nature 
studies  in  the  open :  watching  birds,  squirrels,  rabbits,  and  domestic 
animals,  gardening,  visits  to  the  workshops,  the  bakery,  the  laundry, 
etc. 

Free  play  in  the  open. 

Bed. 

Low-Grade  Schools. 

"A"  Girls.  "B"  Boys. 

Morning  prayer,  talk,  and  hymn. 
A  lesson  in  phonetics,  form,  and  color. 

Exercises    at    blackboards;    simple    drawings    and    reproductions    of 
number  and  word  lessons,  aiding  speech  and  cultivating  observation. 
Cutting  and  sewing  strips  and  winding  balls   for  carpet-looms. 
Knitting.  Braiding  straw  for  hats. 

Calisthenics.  Calisthenics. 

Knitting  and  sewing.  Carpet-weaving. 

Dismissal  in  order.      ■  Dismissal. 

Object-lesson     with     practice       Knitting  caps  and  hoods, 
in  articulation. 

Simple  industrial  occupations 
and  window  gardening. 
Practical  exercises  in  fold- 
ing linen — napkins  and 
clothing  from  laundry. 
Lessons  in  knitting,  cro- 
cheting, and  sewing. 


Tapestry  and  carpet-weaving. 
Basketry  and  mat-making. 
Practical  exercises  in  household  ser- 
vice. 


Exercise  in  the  open  air. 


Military   drill. 


Hand  work,  alternating  with  games,  dancing  and  music. 
Middle-Grade  School. 


"A"  Girls. 
Morning  prayer  and  talk. 
Basket  and  raffia  work. 
Object-lessons. 
Gymnastics. 
Number  work. 


12.00.     Closing  exercises. 


"B"  Boys. 
Morning  prayer  and  talk. 
Sloyd. 

Reading  and  phonetics. 
Object  room. 

Dictation  and  number  work  at  black- 
boards. 
Closing  exercises. 


TRAINING   AND   TREATMENT. 


175 


P.  M. 
2.00 

to 

4.00. 
4.00 

to 

5.00. 

7.00 

to 

8.00. 

A.  M. 

9.00. 

9.15. 


10.00. 

10.30. 

11.00. 

11.30. 

12.00. 
P.  M. 
2.00 

to 

4.00. 


4.00 

to 

5-00. 
7.00 

to 
8.00. 


Straw-braiding,  sewing,  read-       Free-hand     drawing,     clay-modeling, 
ing,  dictation,   writing,  and  and  paper-sloyd;  reading, 

drawing. 


Exercise  in  open  air. 


Military  drill;  gymnastics. 


Hand   work,   alternating  with  story  telling,   reading,   sloyd,   drawing, 
and  modeling. 

High-Grade  Schools  (3  Classes). 
"A."  "B."  "C." 

Morning      prayer    Morning  prayer  and  talk.    Morning  prayer  and  talk. 

and  talk. 
Arithmetic. 


Arithmetic. 


Number  work   with   ob- 
j  ects ;      weights      and 
measures. 
Gymnastics.  Reading  and  spelling.        Object  room. 

Grammar       and 

composition?         Gymnastics.  Gymnastics. 

History  and  cur-    Geography      and      map-    Word       and       sentence 

rent  events.  drawing.  building. 

Geography.  Language    lessons;    his-    Reading  and  writing. 

torical  stories. 
Closing  exercises.    Closing  exercises.  Closing  exercises. 


Reading  and 
spelling ;  sloyd 
o  r  printing ; 
drawing,  mod- 
eling, or  man- 
ual work;  writ- 
ing. 

Exercise  in  open 
air. 


Sloyd ;  obj  ect-1  e  s  s  o  n ; 
free-hand  drawing ; 
modeling ;  sewing,  or 
embroidering ;  tran- 
scribing both  from 
copy  and  from  mem- 
ory; writing. 

Exercise  in  open  air.  Exercise  in  open  air. 


Blackboard  drawing 
geography ;  history 
nature  studies ;  sloyd 
drawing  and  model 
ing. 


Library  alternates  Embroidering    and    sew-    Quiet    games,    story-tell- 

with  band  and  ing   (girls).     Drawing,        ing,  etc. 

orchestra    prac-  modeling   and   carving 

tice.  (boys). 

Treatment. 

Feeble  minds  are  so  often  the  cause,  the  result  of,  or  so  closely 
associated  with  feeble  bodies,  that  an  investigation  into  the  physical 
conditions  and  possible  causes,  including  the  family  history,  the  in- 
fluences of  heredity,  and  of  past  and  present  environment,  the  pres- 


I76  TRAINING   AND   TREATMENT. 

ence  of  positive  defect  which  permanently  arrests,  or  of  disease, 
which  merely  retards  development,  is  most  important  in  making  a 
diagnosis,  and  forms  naturally  the  preliminary  step  in  the  treatment 
of  the  feeble-minded.  Conclusions  thus  reached  give  very  definite 
indications  of  future  possibilities  as  to  improvement  or  deterioration, 
and  also,  by  aiding  in  classification,  greatly  simplify  the  work  of 
training. 

Such  investigation  may  detect  in  some  organ  positive  defect  hith- 
erto unsuspected  for  which  there  is  no  remedy ;  or  it  may  reveal  the 
presence  of  disease  which  may  be  relieved  by  proper  medical  or  sur- 
gical treatment.  Hence  the  importance  of  early  seeking  expert 
opinion  before  disease  develops  permanent  defect.  For  example,  im- 
perfect vision  may  be  some  simple  defect  easily  supplemented  or 
disease  remedied  by  the  ophthalmologist,  and  the  child,  reclaimed 
from  idle  listlessness — the  certain  handmaid  of  degeneration — may 
become  one  of  a  band  of  busy,  happy  workers. 

Defects  of  speech  or  of  breathing  may  require  the  removal  of 
adenoid  growths,  or  some  operation  equally  simple ;  or  examination 
may  show  mental  feebleness  from  deprivation  only,  and  indicate  a 
necessity  of  training  not  for  a  feeble  mind,  but  for  deaf-mutism. 

Malformation  or  disease  of  the  organs  of  generation,  causing  dis- 
comfort or  irritation  in  the  effort  for  relief,  often  establishes  habits 
to  which  the  child  soon  becomes  a  slave.  In  some  of  these  cases  cir- 
cumcision may  prove  necessary,  or  the  surgeon  may  give  still  fur- 
ther relief.  The  removal  of  the  cause ;  strict  cleanliness,  and  often 
a  course  of  treatment  tending  to  keep  open  the  bowels  and  to 
cool  the  blood ;  a  kind  but  firm  discipline,  diversion,  and  an  un- 
ceasing watchfulness  until  a  more  healthful  physical  tone  is  acquired 
and  the  force  of  habit  broken,  will  effect  a  radical  and  permanent 
cure.  This  watchfulness  should  be  yet  more  insistent  as  sexual 
stirrings  arise  and  puberty  approaches.  At  such  times  there  is  al- 
ways safety  in  numbers,  and  the  child  should  never  be  alone.  Free 
play,  interesting  occupations,  a  life  in  the  open,  will  all  contribute  to 
his  betterment,  whereas  a  tendency  to  moody  straying  apart  should 
always  be  discouraged.  Punishment  in  bed  is,  for  obvious  reasons, 
most  unwise,  and  both  moral  and  hygienic  laws  dictate  the  single  bed 
for   both   sexes.     Indeed,   sleeping   or   waking,   these   children   al- 


TRAINING   AND   TREATMENT. 


177 


ways  demand  unceasing  care ;  and  the  frequent  rounds  of  the  night- 
nurse  are  as  essential  as  is  the  oversight  of  the  day  attendant. 

Many  troubled  with  enuresis  may  be  led  to  self-control  through 
medical  treatment,  training,  and  a  little  firm  discipline.  Given 
relief  at  regular  periods  during  the  day  and  night,  and  all  fluids  with- 
held for  at  least  two  hours  before  retiring,  and  for  the  brighter  chil- 
dren, some  slight  penalty  imposed  after  each  dereliction ;  the  treat- 
ment being  thus  moral  as  well  as  physical,  becomes  effective  in  many 
cases.  Careful  diet  and  simple  remedies  should  insure  other  regu- 
larity and  guard  against  diarrhcea,  which  may  often  be  checked  by 
a  few  drops  of  the  extract  of  geranium  maculatum  combined  with 
minute  doses  of  opium,  or  by  the  use  of  a  combinaiton  of  opium  and 
Fowler's  solution,  or  of  chalk-mixture.  If  there  be  constipation 
with  foul  breath  and  furred  tongue,  calomel  in  divided  doses,  or  a 
dose  of  Glauber's,  or  of  Epsom  salts,  is  excellent.  An  enema  of  tepid 
water,  glycerin,  and  soap  weekly,  is  good  routine  treatment. 

This  toning  up  and  maintenance  of  the  physical,  as  conducing  to 
better  mental  conditions,  must  be  the  constant  aim  of  skilled  treat- 
ment. Foremost  among  the  requisites  to  good  health  is  the  proper 
care  of  the  body,  of  which,  without  careful  attention  and  supervision, 
these  children  are  incapable.  This  is  a  truth  that  even  the  tenderest 
of  mothers  will  often  fail  to  grasp ;  as  one  said  to  me  on  returning 
her  great  six-foot  boy  from  a  vacation :  "  He  will  not  wash.  He 
does  not  know  how  to  take  a  bath  anymore  than  a  baby."  It 
is  just  that  lack  of  efficiency  that  never  sees  the  necessity  of  doing 
anything  thoroughly,  that  needs  to  be  constantly  supplemented, 
and  that  poor  mother  had  more  trouble  in  the  care  of  her  one  boy 
than  did  his  trained  attendant  with  twenty.  Neglect  in  this  par- 
ticular breeds  many  ills,  and  poor  circulation,  acid  perspiration,  and 
fetid  breath — the  usual  accompaniments  of  feeble  bodies — must  be 
combated  constantly,  lest  disease  become  deep  seated.  Spongy 
gums  are  most  common,  and  the  teeth  and  mouth  need  frequent 
attention.  Listerine,  Seiler's  tablets  in  solution,  or  a  20  per  cent, 
solution  of  sodium  bicarbonate,  used  freely  as  a  mouth-wash,  after 
each  meal,  are  all  good  aseptics. 

The  ears  must  likewise  be  kept  clean  and  in  good  condition,  as 
clear  audition  greatly  facilitates  progress  in  training,  and  the  child 


I78  TRAINING   AND   TREATMENT. 

cannot  afford  to  lose  any  advantage.  An  occasional  application  of 
cold  cream,  or  of  cosmoline — both  within  and  without — will  prove 
beneficial,  and  a  hair-pin  should  be  introduced  gently  into  the  ear  to 
remove  the  cerumen,  or,  if  there  is  the  slightest  sensitiveness,  a  twist 
of  soft  linen  may  effect  the  purpose. 

The  susceptibility  to  sudden  changes,  free  and  frequent  per- 
spiration, and  a  disposition  to  tuberculosis  always  noticeable,  re- 
quire the  maintenance  of  equable  temperature,  protection  from 
dampness,  and  careful  attention  to  shoes  and  wraps,  as  well  as  to 
other  clothing,  which  in  winter  should  be  light  but  very  warm.  For 
the  same  reason  the  food — given  liberally  in  a  form  that  may  be 
easily  masticated  and  digested — should  be  rich  in  oleaginous  and 
phosphatic  constituents,  and  should  contain  a  fair  amount  of  nitro- 
genous elements.  Green  vegetables  and  fruit  are  especially  whole- 
some, as  there  is  generally  more  or  less  tendency  to  scrofula. 
Simple  desserts,  candy,  or  other  sweets  are,  it  is  needless  to  say, 
best  given  at  mid-day.  If  necessary  at  all  between  meals,  food 
should  be  of  the  simplest — milk  and  bread,  or  a  bun  always  being 
best.  In  view  of  the  fact  that  malnutrition,  often  through  succes- 
sive generations,  is  frequently  at  the  root  of  the  trouble,  the  impor- 
tance of  this  continual  building-up  by  means  of  a  liberal  and  varied 
dietary,  of  bathing  and  exercise,  occupation  and  repose  alternating 
regularly,  and  the  additional  invigoration  of  massage,  and  tonics  when 
necessary,  becomes  self-evident.  Lack  of  proper  food  or  of  proper  as- 
similation ;  want  of  repose,  occasioned  often  by  highly  nervous  states  ; 
an  absence  of  purpose  or  of  proper  incitement,  have  each  or  all 
combined  to  bring  about  a  starved  existence;  and  the  diseases  to 
which  the  feeble-minded  are  most  liable,  plainly  point  to  such  con- 
dition. 

Malnutrition  may  exist  in  utero  or  originate  during  the  nursing 
period.  This  is  as  common  among  the  wealthy,  as  among  the  labor- 
ing or  the  pauper  class,  for  in  all  classes  of  life  there  are  mothers 
unfit,  unable,  or  unwilling  to  devote  themselves  to  the  work  of  bear- 
ing, nursing,  and  rearing  children.  How  few  really  feel  themselves 
called  to  the  profession  of  motherhood,  a  profession  to  which  the 
claims,  the  excitements,  and  the  vices  of  society  life  are  often  as 
antagonistic  as  are  the  cares  and  anxieties,  the  brutalities  and  crimes 


TRAINING   AND   TREATMENT.  1 79 

of  the  other  classes.  No  woman  laboring  under  any  stress  of  living 
is  capable  of  bearing  or  of  nursing  a  healthy  child ;  similarly  in  some 
cases  a  wet-nurse  may  be  as  entirely  disqualified  for  purposes  of 
feeding  as  is  a  bottle  of  unsterilized  milk.  If  added  to  this,  there  be 
absence  of  modern  means  of  cleansing,  improper  ventilation,  insuffi- 
cient warmth,  or  periods  of  isolation  alternating  with  excitement 
equally  pernicious,  the  child  is  easily  launched  into  a  deficient  life. 

There  is  much  predisposition  among  the  feeble-minded  to  lung 
trouble,  coupled  with  a  lack  of  resisting  power;  tuberculosis  in 
various  forms,  pneumonia,  pleurisy,  and  bronchitis  are  common. 
Tonsillitis,  pharyngitis,  laryngitis  and  rheumatism  are  frequent 
among  the  higher  grades,  but  asthma  is  comparatively  rare. 

Ephemeral  fevers  are  often  observed,  the  temperature  frequently 
running  so  alarmingly  high  that  fatal  results  seem  inevitable,  when 
subsidence,  often  quite  as  sudden  follows,  in  response  to  or  even 
without  simple  remedies. 

Heart-diseases  are  frequently  encountered ;  deficient  circulation 
being  evidenced  in  the  cyanosed  hands  and  feet  and  blue  lips  so  char- 
acteristic of  low-grade  imbeciles  and  idio-imbeciles,  especially  those 
of  the  Mongolian  type. 

The  sluggish  habits  of  defective  children  show  themselves  in  fre- 
quent attacks  of  constipation,  diarrhoea,  dysentery,  gastritis,  and  the 
various  forms  of  indigestion.  Merycism  is  very  common  among 
the  lower  grades,  and  these  children  are  peculiarly  liable  to  exanthem- 
atous  diseases,  due  in  a  measure  to  inertia  and  imperfect  circulation. 

Eczema  in  its  manifold  forms  is  persistent,  recurring  ever  and 
again  and  lingering  sometimes  for  years  in  spite  of  treatment  and 
care.  Rupia,  tinea,  acne,  alopecia,  impetigo,  urticaria,  lichen, 
herpes,  and  erythema  nodosum  are  noticed  not  infrequently.  Herpes 
zoster  is  not  common.  Of  adenoma  sebaceum  or  "  butterfly  disease  " 
of  which  but  21  cases  so  far  are  recorded,  I  have  had  4  under  my 
own  care  and  have  a  personal  knowledge  of  3  others.  (See  chap- 
ter XIII.) 

Ulcers,  especially  on  legs,  are  frequent,  obstinate  and  slow  in  re- 
sponding to  treatment.  Gastric  ulcers  occur  with  boys,  but  rarely 
among  girls. 


l80  TRAINING   AND   TREATMENT. 

Hemorrhoids,  rare  in  the  lower  grades,  are  more  frequent  in  the 
higher  and  middle  grades  of  both  sexes ;  this  is  true  also  of  prolapse 
of  the  rectum  and  of  hernia.  Menstrual  derangements  are  not 
common. 

Defective  vision  is  noticeable  in  fully  90  per  cent,  of  the  high  and 
middle  grades,  and  among  the  low  grades  there  is  much  conjunc- 
tivitis, iritis,  corneal  ulcer,  blepharitis,  and  photophobia.  Tests  and 
class  work  in  the  schools  reveal  a  fair  possession  of  the  color-sense, 
and  color-blindness  is  the  exception  rather  than  the  rule. 

Partial  deafness  is  occasionally  encountered;  absolute  deafness, 
uncommon  among  the  idio-imbecile  and  the  idiot  classes,  is  found 
in  the  higher  grades.  Earache  is  a  frequent  complaint,  as  is  also 
purulent  otorrhea  and  otitis  media,  to  which  both  sexes  are  subject. 
Hematoma  auris  I  have  found  in  25  per  cent,  of  boys,  confined 
almost  exclusively  to  the  left  ear,  two  cases  only  being  double. 

Adenoid  growths  are  a  fruitful  source  of  speech-defect,  in  the 
high  and  middle  grades,  and  early  removal  greatly  facilitates  train- 
ing in  articulation. 

Nervous  diseases,  such  as  Friedreich's  ataxia,  syringomyelia,  and 
hydromyelia  which  would  seem  to  be  allied  to  brain  defect,  are  prac- 
tically unknown ;  anterior  poliomyelitis  is  occasional,  but  the  nervous 
diseases  most  common  are  the  cerebral  palsies  of  childhood.  Hys- 
teria is  peculiar  to  the  high  and  middle  grades,  as  is  also  meningitis, 
to  which  both  girls  and  boys  are  subject. 

Among  the  girls,  neuralgias  are  common.  Chorea  is  fairly  rare, 
not  being  found  at  all  among  the  lower  grades,  and  in  only  about 
5  per  cent,  of  the  higher.  Epilepsy,  confined  almost  exclusively  to 
the  imbecile  and  idio-imbecile  classes,  is  rarely  seen  in  the  idiot. 

Almost  entire  hebetude  to  pain  is  noticeable,  many  being  able  to 
endure  the  sewing-up  of  a  wound  or  the  amputation  of  a  finger  with- 
out flinching.  In  fact,  they  rather  enjoy  anything  that  brings  them 
into  notice  and  so  gratifies  their  egotistic  sense.  Nostalgia  is  prac- 
tically unknown,  feeble-minded  children  adapting  themselves  easily 
to  change  of  environment. 

In  hospital  wards  we  encounter  all  sorts  of  anomalies,  one  seem- 
ingly at  the  very  gate  of  the  grave,  with  scarcely  a  pulsation  or  a 
breath,  will  suddenly  revive  and  recuperate,  whereas  another,  sue- 


Plate  XXXI. 


TRAINING   AND   TREATMENT.  l8l 

cumbing  to  some  light  attack,  passes  without  warning.  In  these  lat- 
ter cases  the  necropsy  generally  reveals  tissues  absolutely  worthless 
— a  poor  make-up,  which  unable  to  resist,  goes  to  pieces  on  the 
slightest  provocation.  Many  die  in  early  childhood  because  too 
feeble  to  resist  any  sudden  attack;  others,  physiologically  old,  die  of 
old  age  in  early  youth. 

An  interrogation  frequently  and  eagerly  put  by  anxious  parents 
is :  "  Will  there  not  be  a  change  in  my  child  in  the  seventh,  or  four- 
teenth, or  twenty-first  year?  I  thought  he  would  outgrow  his  de- 
fect." To  this  there  is  but  one  answer !  He  who  is  born  into  this  sad 
heritage,  leaves  hope  behind.  We  cannot  cure  what  is  not  disease, 
but  defect,  and  that  which  the  cradle  rocks  the  spade  will  cover. 


CHAPTER   VII. 

craniectomy  and  asexualization. 

Craniectomy. 

Craniectomy  is  a  singular  exception  to  many  brilliant  successes  that 
have  attended  surgical  demonstration  of  scientific  theory.  Studies 
in  etiology  and  experiments,  in  treatment  of  microcephalic  idiocy,  de- 
veloped a  theory  that  possibly  the  premature  closing  of  the  fonta- 
nelle,  and  the  ossification  of  the  cranial  sutures,  had  arrested  the 
growth  of  the  brain  which,  thus  locked  in  a  cell  of  bone,  could  no 
longer  expand,  nor  attain  to  functional  activity.  The  logical  deduc- 
tion from  such  reasoning  was,  that  expansion  would  follow  the  re- 
opening of  the  skull  with  consequent  development  of  the  brain,  and 
thus  the  operation  would  prove  an  open  door  to  future  intelligence. 
Nor  was  this  theory  wholly  without  basis,  for  there  had  been 
cases  showing  unmistakable  signs  of  pressure,  the  result  either  of 
accident  or  of  an  undoubted  history  of  premature  closure  of  the 
fontanelle ;  but  these  were  rare  exceptions,  and  certainly  not  cases  of 
true  microcephaly. 

The  first  to  put  into  practice  the  theory  formulated,  was  Fuller, 
of  Montreal,  Canada,  who  in  1878  operated  upon  an  idiot  two  years 
old,  the  only  result  claimed  being  some  slight  mental  improvement, 
after  temporary  paralysis. 

In  the  case  of  a  second  experiment  made  some  years  later  by 
Lane  in  the  United  States,  the  patient  died  within  fourteen  hours 
after  the  operation. 

During  the  year  of  1890,  investigations  were  pursued  coincident- 
ally  in  France,  England,  and  America,  by  men  all  eminent  in  the 
profession — Lannelongue  of  Paris,  Victor  Horsley  of  London,  and 
W.  W.  Keen  of  Philadelphia.  Some  56  operations,  by  John  Bar- 
low, Boekel,  Peau  and  others  followed  in  rapid  succession.  Of  these, 
13  died,  and  for  24  only,  of  the  43  children  who  recovered,  a  very 
slight  improvement  was  claimed. 

182 


CRANIECTOMY.  1 83 

Of  25  microcephalic  idiots  operated  upon  by  Lannelongue,  i 
died  from  the  immediate  effects,  but  for  the  others  improvement 
in  greater  or  less  degree  was  claimed ;  one  a  mute,  it  was  said,  learned 
in  a  short  time  to  talk,  and  another,  four  years  old,  ceased  incessant 
crying  and  began  to  try  to  talk  and  to  walk. 

Lannelongue's  methods  of  procedure  were  linear  craniectomy  and 
craniectomie  a  lambeaux,  and  he  regarded  the  systematic  training 
of  the  child  subsequently,  so  essentially  a  part  of  the  treatment,  as 
to  reserve  his  opinion  until  the  patient  had  been  for  a  satisfactory 
period  under  training. 

Horsley's  experience  was  evidently  not  encouraging,  as  he  ex- 
pressed himself  to  me  some  six  years  later  as  being  no  advocate  of 
craniectomy,  considering  it  an  experiment  of  the  past. 

Keen  in  a  talk  before  the  Association  of  Medical  Offices  of  Amer- 
ican Institutions,  at  Elwyn  in  1892,  spoke  of  craniectomy  as  a  most 
dangerous  operation;  of  50  cases  coming  under  his  observation, 
25  per  cent,  had  terminated  fatally.  This  excessive  mortality  he 
ascribed  to  the  fact  that  nearly  all  microcephals  are  poorly  de- 
veloped and  of  necessity  feeble,  with  no  resisting  power.  He  told 
how  he  explained  to  parents  that  fully  1  in  4  died;  that  even 
if  the  child  survived,  there  might  be  no  improvement,  the  prob- 
abilities being,  however,  that  there  would  be  some  moderate  improve- 
ment— perhaps  only  after  years;  but  that  they  must  not  expect  the 
child  to  become  anything  like  a  normal  adult.  He  further  added : 
"  In  many  cases  where  very  great  improvement  has  been  reported, 
I  think  the  report  has  been  colored  by  the  hopeful  wish  that  a  good 
many  of  us  are  apt  to  entertain — the  wish  has  been  father  to  the 
thought.  In  the  cases  I  have  operated  on,  in  not  one  has  there  been 
a  sudden  improvement.  There  has  been  a  gradual,  slow,  moderate 
improvement :  at  no  time  has  it  come  by  a  great  leap  or  jump." 

Some  three  years  later  I  requested  Dr.  Keen,  at  that  time  a  mem- 
ber of  the  medical  board  of  the  Pennsylvania  Training  School,  to 
examine  some  of  our  children  at  Elwyn  with  a  view  to  operating, 
but  he  declined;  and  experience  has  since  led  him  to  modify  even 
the  very  conservative  views  then  expressed  and  to  coincide  with  his 
colleagues,  Bourneville,  Horsley,  Ireland,  Shuttleworth,  Beach,  Cun- 
ningham, Telford-Smith  and  others  in  the  opinion  that  it  is  the  lack 


1 84  CRANIECTOMY. 

of  quality  of  brain  that  affects  growth,  and  therefore  it  is  the  brain 
that  moulds  the  skull — not  the  skull  that  cramps  the  brain. 

Not  only  does  skull  capacity  fail  to  be  increased  by  the  operation, 
but  there  is  absolute  danger  of  it  being  diminished  by  the  contrac- 
tion of  fibrous  cicatricial  tissue;  moreover  examination  most  care- 
ful fails  to  reveal  in  the  brains  of  microcephals  the  slightest  evidence 
of  compression.  The  brains  are  found  not  adhering  to  the  mem- 
branes, but  free  and  well  separated,  showing  that  the  brain  has  deter- 
mined the  size  of  the  cranium  and  the  cranium  has  simply  accommo- 
dated itself  to  it. 

Sir  George  Humphrey  gives  as  the  result  of  his  examination  of 
nineteen  microcephalic  skulls :  "  There  is  nothing  in  the  specimens 
to  suggest  that  the  deficiency  in  the  development  of  the  skull  was 
the  leading  feature  in  the  deformity  and  that  the  smallest  of  the 
bony  cerebral  envelopes  exerted  a  compressing  or  dwarfing  influence 
on  the  brain,  or  anything  to  give  encouragement  to  the  practice  lately 
adopted,  in  some  instances,  of  removal  of  a  part  of  the  bony  case, 
with  the  idea  of  affording  more  space  and  freedom  for  the  growth 
of  the  brain.  In  these,  as  in  other  instances  of  man  and  the  lower 
animals,  the  brain-growth  is  the  determining  factor,  and  the  skull 
grows  upon  and  accommodates  itself  to  the  brain,  whether  the  latter 
be  large  or  small.  This  view  is  corroborated  by  the  fact  that,  in  the 
brains  taken  from  several  of  the  microcephalic  skulls,  the  convolu- 
tions of  the  brain  give  no  indication  of  compression,  but  are  free, 
outstanding,  and  separated  by  well-marked  sulci." 

Professor  Cunningham,  of  Trinity  College,  Dublin,  after  an  ex- 
haustive examination  of  two  microcephalic  brains,  writes  as  follows : 

"  The  view  that  the  arrest  in  brain-development  was  due  to  a 
growth  restriction,  brought  about  by  a  failure  on  the  part  of  the 
cranial  cavity  to  expand  to  the  required  extent,  is  untenable,  because 
it  is  now  known  that  the  early  closure  of  the  cranial  sutures  is  by 
no  means  a  distinguishing  feature  of  the  microcephalic  skull.  It  is 
evident,  from  the  condition  of  the  two  brains,  that  the  arrest  in 
growth  has  taken  place  at  a  period  corresponding  to  the  third  or 
fourth  month  of  fetal  development,  or,  in  other  words,  at  a  time 
when  sutural  closure  is  altogether  out  of  the  question,  seeing  that 
at  this  stage  the  ossification  of  the  cranial  bones  has  only  advanced 


Plate  XXXII. 


Case  A. 
AMERICAN   INDIAN  TYPE. 


CRANIECTOMY.  1 85 

to  a  very  small  extent.  It  is  not  going  too  far  to  say  that  all  anato- 
mists of  the  present  day  who  have  studied  the  question  have  aban- 
doned this  view,  and  the  tendency  now  is  to  consider  cranial  growth 
as  being  subsidiary  to,  and  dependent  upon,  brain  growth.  Still, 
old  theories  die  hard,  and  when  they  are  proved  to  be  erroneous  it 
is  well,  for  a  time  at  least,  to  reiterate  the  evidence  against  them. 
This  is  all  the  more  necessary  in  the  present  case,  seeing  that  in 
recent  years  operative  procedure  has  not  only  been  proposed,  but  in 
several  cases  carried  out,  with  a  view  of  relieving  the  supposed  cran- 
ial restraint  upon  the  growth  of  the  microcephalic  brain.  We  have 
no  hesitation  in  saying  that  it  would  be  quite  as  rational  a  proceeding 
to  operate  on  the  head  of  an  ape  in  the  hope  of  producing  an  access 
of  brain-growth  as  upon  the  head  of  a  recent  typical  case  of  micro- 
cephaly." 

Shuttleworth  says :  "  I  think  we  may  conclude  that  craniectomy 
is  but  rarely,  if  ever,  of  permanent  benefit  in  cases  of  ordinary  con- 
genital microcephalus  in  which  the  original  defect  is  in  the  brain, 
not  in  the  bone ;  but  that  it  may  possibly  do  good  by  relieving  pres- 
sure symptoms  and  favoring  brain  development  where  premature 
synostosis  is  the  result  of  osseous  hypertrophy  from  constitutional 
causes.  The  diagnosis  of  appropriate  cases  is,  however,  beset  with 
difficulties." 

Fletcher  Beach  says :  "I  do  not  see  how  grave  lesions  of  the 
brain,  which  are  often  present  in  these  cases,  can  be  benefited  by 
craniectomy." 

Telford  Smith  says :  "  The  weight  of  evidence  so  far  is,  I  think, 
against  the  operation  of  craniectomy,  as  judged  not  only  from  the 
facts  learned  from  an  examination  of  microcephalic  brains,  micro- 
cephalic skulls,  and  of  skulls  in  which  the  operation  has  been  per- 
formed, but  also  as  judged  from  the  actual  mental  and  physical  re- 
sults obtained  in  even  those  cases  where  all  the  circumstances  were 
favorable." 

Bourneville  affirms  that  not  only  is  there  no  expansion  of  the  cavity 
of  the  cranium,  but  that  it  is  encroached  on  by  exuberance  of  bony 
matter  thrown  out  to  repair  the  breaches  made  by  the  surgeon.  In 
a  paper  presented  before  the  French  Academy,  showing  results  of 
craniectomy  upon  idiot  children  at  Bicetre,  he  condemns  the  prac- 


1 86  CRANIECTOMY. 

tice  in  toto.  While  viewing  with  him  in  the  Musee  Anatomo- 
pathologique,  at  Bicetre,  some  350  skulls — mainly  idiot,  many  micro- 
cephalic— that  had  been  craniectomized,  he  pointed  out  to  me  the 
absence  of  any  signs  of  premature  ossification ;  indeed  the  amount  of 
space  gained  by  the  operation  would  have  afforded  very  inconsider- 
able opportunity  for  expansion,  whatever  the  capacity  might  have 
been.  As  Monsieur  characteristically  put  it :  "  It  might  do  for  the 
American  idiot,  but  for  the  French,  c'est  impossible!" 

I  have  yet  to  see  or  to  learn  of  a  case  that  has  been  sufficiently 
benefited  to  warrant  the  discomfort,  not  to  speak  of  the  danger,  inci- 
dent to  the  operation ;  and  even  should  the  risk  to  life  be,  through 
advance  in  surgery,  reduced  to  a  minimum,  I  should  still  unhesitat- 
ingly advise  against  it.  For  the  theory  of  pressure  acting  as  a 
dwarfing  process,  having  been  so  disproved  through  data  collected 
from  observation  of  the  living  subject,  as  well  as  from  examinations 
of  both  brains  and  skulls,  is  no  longer  entertained  by  reputable  sur- 
geons and  alienists. 

While  scientists  were  investigating,  experimenting  and  cautiously 
rejecting  all  evidence  that  failed  to  verify,  quacks  and  charlatans 
of  all  sorts  took  up  the  cry  and  stimulated  by  the  daily  press  and  the 
novelist,  all  eager  for  sensation,  the  cutting  open  of  heads  soon  be- 
came a  fad.  In  the  Strand  Magazine  a  story  with  the  sensational 
title  "  Creating  a  Mind  "  was  read  from  ocean  to  ocean.  Later  "  A 
Wonderful  Surgical  Operation,"  was  the  title  of  an  article  in  one 
of  the  leading  magazines  of  America ;  the  opening  sentence,  "  Can 
you  think  of  an  operation  that  would  create  a  mind  ?  "  was  enough 
in  itself  to  awaken  a  hopeless  hope  in  the  hearts  of  sorrowing  pa- 
rents, but  it  goes  on  to  say :  "  The  patient  was  a  child  about  one 
year  old,  of  good  parentage  and  of  healthy  bodily  growth,  aside  from 
the  fact  that  its  skull  was  that  of  a  new-born  child,  and  it  had  hard- 
ened and  solidified  into  that  shape  and  size.  The  soft  spot  was  not 
there,  and  the  sutures  or  seams  of  the  skull  had  grown  fast  and  solid, 
so  that  the  brain  within  was  cramped  and  compressed  by  its  unyield- 
ing bony  covering.  The  body  could  grow — did  grow — but  the  poor 
little  compressed  brain,  the  director  of  the  intelligent  and  voluntary 
actions  of  the  body,  was  kept  at  its  first  estate.  Even  more  than 
this,  the  struggle  within  its  bony  cage  made  a  pressure  'which  caused 


CRANIECTOMY.  1 87 

distortion,  and  aimless  or  unmeaning  movement.  The  arm  and  leg 
turned  in,  in  that  helpless  pathetic  way  that  tells  of  imbecility." 
Then  follows  an  account  of  the  operation,  and  the  statement  that  in 
three  days  the  child  showed  improved  mentality;  in  eight  days  the 
improvement  had  become  a  certainty,  and  from  an  "  it "  it  had  been 
transformed  into  a  "  he,"  and  "  the  child  is  now  a  child,  who  acts 
and  thinks  like  other  children  .  .  .  and  makes  glad  the  hearts  of 
those  who  love  him."  A  very  pretty  romance,  but  absolutely  mis- 
leading, worthless,  and  untrue! 

Early  in  my  experience,  my  chief  sent  for  me  one  morning  and, 
placing  in  my  hands  a  paper  containing  a  sensational  account  of  an 
operation  performed  two  days  previous  in  a  hospital  in  a  neighboring 
city,  told  me  to  follow  up  the  case  and  report  to  him.  The  child  was 
said  to  be  a  microcephalic  idiot  aged  five  years.  Directly  after  the 
operation  (the  craniectomy  having  been  both  longitudinal  and  trans- 
verse) the  child  had  spoken — so  the  account  said — and  reached  for 
the  nurse's  glasses.  After  waiting  for  over  two  hours  in  the  hos- 
pital and  being  transferred  from  one  interne  to  another,  without 
gleaning  any  information,  I  finally  reached  the  surgeon  who  had 
performed  the  operation,  who  replied  most  brusquely  to  my  inquiries : 
"  There  is  nothing  to  tell.  The  craniectomy  was  performed  and  the 
child  died  within  eight  hours.  What's  that?  Spoke  and  reached 
after  the  nurse's  glasses !  Well  that's  .  .  . !  He  did  no  such  thing  ; 
nothing  but  cry,  and  in  his  struggles  knocked  off  the  glasses.  Good 
morning !  " 

One  of  the  most  skillful  surgeons  in  Philadelphia,  one  of  world- 
wide reputation,  related  to  me  the  following : 

"  A  child  of  nine  years  was  brought  to  me.  He  had  a  good,  large 
head,  but  it  was  asymmetric;  there  was  faulty  development  in  the 
teeth,  eye-sight,  and  general  growth  of  the  body,  and  he  was,  un- 
doubtedly, an  imbecile.  I  declined  to  operate,  telling  the  mother 
that  surgery  offered  nothing  to  such  a  child.     '  But  what  of  all  the 

marvelous  cures  I  hear  Dr.  has  made  ? '  she  replied.     '  Two 

hundred  operations  without  a  death,  and  with  most  extraordinary 
results.  He  assured  us  that  if  we  would  allow  him  to  operate  on 
our  boy  it  would  be  a  perfect  revelation  to  us,  and  cited  one  particu- 
lar case  at  Elwyn  of  an  idiot  girl  of  fifteen,  whom  he  had  operated 
upon,  and  who  became  very  nearly  normal.'  " 


1 88  CRANIECTOMY. 

The  facts  regarding  the  Elwyn  case  are  these:  the  subject,  a 
moral  imbecile  of  high  grade,  handsome  and  well  formed  physically, 
quite  bright  mentally,  had  made  rapid  progress  in  school,  in  hand- 
work and  in  household  service ;  but  with  perverted  moral  sense, 
quick  to  choose  evil  and  to  refuse  good,  was  disobedient,  obstinate, 
passionate,  untruthful,  and  a  nymphomaniac.  The  mother,  during 
a  vacation,  had  taken  her  to  a  surgeon  whose  fad  was  craniectomy, 
and  he  had  operated.  Why,  I  do  not  know,  for  there  was  not  the 
slightest  evidence  of  microcephalus  or  of  pressure.  The  case  mis- 
represented— whether  wilfully  or  not — as  one  of  profound  idiocy, 
naturally  occasioned  misconception.  The  girl  even  in  the  hospital 
ward  was  the  subject  of  comment  and  of  idle  curiosity,  and  later,  the 
opinion  of  a  great  artist,  to  whom  she  was  exhibited,  that  the  result 
was  little  short  of  miraculous,  was  largely  quoted  as  confirmatory  of 
cure.  In  reality  what  he  saw  was  just  what  she  was  both  before  and 
after  the  operation — no  more  and  no  less. 

Murdoch  reports  three  cases  between  the  ages  of  six  and  twelve, 
not  microcephalic  nor  with  any  evidence  of  injury  to  the  skull,  where 
there  was  slight  improvement  after  craniectomy,  but  they  remain 
hopelessly  imbecile  and  "  the  improvement  is  in  no  sense  greater 
than  is  to  be  expected  from  systematic  training  of  any  imbecile  chil- 
dren of  low  grade." 

Carson,  of  Syracuse,  reporting  three  children  craniectomized, 
says :  "  Our  observation  of  these  cases  has  not  been  of  a  character 
to  lend  encouragement  to  the  operation.  We  have,  therefore,  no 
faith  whatever  in  the  operation  of  craniectomy,  and  in  the  wonder- 
fully improved  conditions  which  are  said  to  result  from  it,  except, 
possibly,  in  well-selected  cases  of  microcephalus,  in  very  young  sub- 
jects, where  the  fontanels  closed  and  the  sutures  ossified  prematurely. 
But  no  such  cases  have  come  under  our  observation." 

Voisin  says  of  twenty  cases  that  the  much-vaunted  intellectual 
ameliorations  did  not  follow. 

In  some  dozen  cases  operated  upon  before  coming  to  me,  and 
under  my  observation  now  for  many  years,  I  note  no  improvement 
that  can  be  traced  to  the  operation ;  in  fact  they  are  inferior  in  men- 
tality to  many  of  their  grade. 


Plate  XXXIII 


MONGOLIAN   TYPE. 


asexualization.  1 89 

Asexualization. 

The  consideration  of  treatment  naturally  includes  that  of  preven- 
tion. In  fact  it  was  to  the  prevention  of  defect  rather  than  to  its 
treatment  that  ancient  peoples  gave  attention.  Esteeming  a  maimed 
existence  one  accursed  of  the  gods,  recognizing  the  evil  it  must  en- 
tail, and  holding  the  preservation  of  the  mere  individual  secondary 
to  that  of  the  integrity  of  the  race,  they  permitted  their  defectives  to 
perish,  and  in  so  doing  did  but  follow  natural  law — imperfect  seeds 
and  buds  dwindle  and  die,  defective  fruit  falls  from  the  bough  and 
weaklings  of  the  flock  perish.  We  ourselves  choose  and  set  apart 
with  care  the  animals  best  fitted  for  breeding,  and  by  castration  ren- 
der more  docile  because  less  passionate,  the  beasts  of  burden  who, 
because  harmless,  may  rove  at  will  unrestrained  to  mingle  with  the 
common  herd.  Yet  we  do  not  exercise  the  same  discrimination  in 
race  culture.  To  the  ignorant  and  to  the  foolish  equally  with  the 
wise  and  the  capable,  is  permitted  the  sacred  office  of  the  life-giver, 
and  with  rare  exceptions  the  law  gives  sanction  without  protest; 
apparently  indifferent  to  results,  evidenced  not  alone  in  the  rapid 
increase  of  defect  and  disease,  but  also  in  the  general  nervous  ex- 
citability which  is  characteristic  of  the  age.  It  is  the  lack  of  patient 
reposeful  power — the  inability  to  meet  or  to  sustain  crises — that  is 
the  true  cause  of  the  frequency  of  crime  desolating  homes ;  divorces, 
murders,  and  suicides  being  too  often  the  direct  outcome  of  neurotic 
heredity. 

I  know  of  no  restraining  law  in  England  or  on  the  continent  of 
Europe;  and  but  few  of  our  states  have  legislated  upon  the  subject. 
Of  these  latter,  Connecticut  is  foremost  and  most  explicit  in  a  pro- 
hibitory law,  approved  July  4,  1895 :  "  No  man  and  woman  either 
of  whom  is  epileptic,  or  imbecile,  or  feeble-minded,  shall  inter-marry, 
or  live  together  as  husband  and  wife  when  the  woman  is  under  forty- 
five  years  of  age.  Any  person  violating  or  attempting  to  violate  any 
of  the  provisions  of  this  section,  shall  be  imprisoned  in  the  state 
prison  not  less  than  three  years." 

"  Every  man  who  shall  carnally  know  any  female  under  the  age 
of  forty-five  years  who  is  epileptic,  imbecile,  or  feeble-minded,  or 
pauper,  shall  be  imprisoned  in  the  state  prison  not  less  than  three 
years.     Every  man  who  is  epileptic  who  shall  carnally  know  any 


I9O  ASEXUALIZATION. 

female  under  the  age  of  forty-five  years,  and  every  female  under  the 
age  of  forty-five  years  who  shall  consent  to  be  carnally  known  by  any 
man  who  is  epileptic,  imbecile,  or  feeble-minded,  shall  be  imprisoned 
in  the  state  prison  not  less  than  three  years." 

,  This  undoubtedly  shows  an  appreciation  of  the  necessity  for  pro- 
tection, but  the  question  arises :  Is  this  a  protection  that  protects  ? 
For  the  law-abiding,  contemplating  marriage ;  or  to  those  irresponsi- 
bles,  fortunate  in  the  possession  of  guardians,  it  is  comprehensive 
enough  to  prove  a  check  entire ;  but  the  waifs  and  strays,  the  vicious 
and  lawless,  and  above  all  the  unrecognized,  unsuspected  defectives 
in  all  ranks  of  society,  it  is  powerless  to  reach;  and  it  is  through 
these,  that  the  careful  work  of  these  faithful  law-makers  is  undone, 
and  increase  goes  on ;  moreover  history  shows  that  among  any  people 
in  every  age  wherever  stringent  marriage  laws  are  enforced,  the  in- 
evitable result  has  been  free-love,  concupiscence  and  prostitution.  It 
is  impossible  to  legislate  for  conscience  at  the  best,  and  in  dealing 
with  the  low  and  the  bestial,  with  the  ignorant  and  the  weak,  the 
silly  and  the  irresponsible  with  utter  incapacity  to  comprehend  any 
law  but  that  of  self-will,  there  is  nothing  to  convert  or  to  convince, 
for  the  moral  sense  is  not  there  to  appeal  to. 

For  these,  and  against  these — festering  sores  in  the  life  of  society 
— the  only  protection  is  that  which  the  surgeon  gives;  and  slowly 
and  reluctantly  society  is  coming  to  recognize  this  fact,  and  that 
which  was  spoken  of  behind  closed  doors,  already  begins  to  be  the 
subject  of  open  discussion  and  to  appear  in  reputable  journals  of  the 
day.  It  is  urged,  not  only  as  a  direct  means  of  preventing  that  direct 
transmission  of  defect,  which  as  statistics  prove  is  a  law  governing 
the  cohabitation  of  defectives,  but  because  in  large  communities 
where  they  can  best  be  trained  and  find  truest  happiness  and  success 
in  life,  association  of  the  sexes  both  in  labor  and  in  amusements,  con- 
tributes to  the  comfort  and  well-being  of  all.  Now  such  association 
of  large  numbers  of  irresponsible  "  children  "  with  sexual  impulses 
exaggerated,  could  never  be,  without  such  safe-guard ;  which  in 
freeing  them  from  the  domination  of  sexual  appetite,  would  free 
them  also  from  the  necessity  of  perpetual  surveillance  and  permit  a 
certain  amount  of  liberty  which  every  individual,  in  any  condition 
of  life,  craves  as  essential  to  his  happiness. 


ASEXUALIZATION.  I9I 

It  has  been  advanced  that  the  fear  of  consequences  is  the  chief, 
indeed,  often  the  only  check  upon  the  vicious ;  and  that  to  remove 
this  is  to  offer  a  premium  for  vice,  and  an  open  door  to  indiscrim- 
inate intercourse,  if  not  to  absolute  prostitution.  However  true  this 
may  be  with  the  adult  who  seeks  through  this,  an  easy  path  to  trans- 
gression, and  for  whom  asexualization  does  not  allay  desire ;  there 
is  sufficient  evidence  to  show  that  the  operation  performed  before 
the  critical  period  results  very  differently,  and  that  the  child  thus 
treated  passes  simply  and  unconsciously  into  that  placidity,  freedom 
from  excitement,  and  consequent  content  with  the  ordinary  pursuits 
of  life  that  marks  advanced  age.  Even  lasciviousness,  vulgarity 
and  obscenity  would  become  so  modified  that  general  oversight  of 
numbers  would  have  to  concern  itself  chiefly  with  checking  misde- 
meanors and  improprieties,  whereas  now  it  must  forever  forestall 
opportunities  for  immoralities. 

Let  asexualization  be  once  legalized,  not  as  penalty  for  crime  but 
a  remedial  measure  preventing  crime  and  tending  to  the  future  com- 
fort and  happiness  of  the  defective ;  let  the  practice  once  become 
common  for  young  children  immediately  upon  being  adjudged  de- 
fective by  competent  authorities  properly  appointed,  and  the  public 
mind  will  accept  it  as  a  matter  of  course  in  dealing  with  defectives ; 
and  as  an  effective  means  of  race  preservation  it  will  come  to  be 
regarded  just  as  is  quarantine — simply  a  protection  against  ill.  The 
fact  that  the  practice  has  been  perverted  to  selfish  and  vicious  uses, 
does  not  affect  the  argument  that  the  experience  of  many  peoples 
in  many  ages  has  compelled  a  resort  to  it  to  preserve  order  in  special 
social  conditions  of  the  times.  For  this  reason  it  was  sanctioned  in 
the  kingdom  of  Lydia,  and  in  all  polygamous  countries  eunuchs  were 
a  necessity  as  guards  to  women,  and  to  preserve  the  order  of  the 
harem.  The  Greeks  and  Romans  also  had  their  eunuchs,  and  there 
is  mention  of  these  in  Scripture.  In  various  countries,  in  both  an- 
cient and  modern  times,  among  Orientals,  Aztecs,  and  Australians, 
there  are  traces  of  the  practice  having  a  religious  significance.  In 
Russia  there  is  a  sect  known  as  the  Skoptzies — castrated,  calling 
themselves  "  White  Doves,"  who  practice  asexualization  as  a  means 
to  the  attainment  of  a  life  of  social  purity.  These  doubtless,  as  do 
many  fanatics,  founding  their  belief  upon  some  one  portion  of  Scrip- 


192  ASEXUALIZATION. 

ture  may  find  their  warrant  in  that  single  allusion  to  those  who  are 
"  eunuchs  for  the  Kingdom  of  Heaven's  sake  " ;  St.  Matthew,  xix. 
12. 

Following  close  upon  open  discussion  an  effort  was  made  to  arrive 
at  a  consensus  and  an  authoritative  expression  of  opinion.  In  this 
Pennsylvania  leads,  in  1897,  in  a  circular  emanating  from  Elwyn, 
addressed  to  the  heads  of  various  institutions  for  mental  defectives 
both  here  and  abroad,  containing  the  following  queries : 

"  I.  In  what  proportion  of  the  inmates  of  your  institution  do  you  consider 
procreation  advisable? 

"  2.  In  what  proportion  of  the  inmates  of  your  institution  do  you  consider 
procreation  possible? 

"  3.  What  would  be  the  probable  effect  of  asexualization  upon  their  mental 
and  moral  conditions? 

"4.  What  effect  upon  their  physical  condition? 

"  5.  What  operation  would  you  advise  upon  a  male — removal  of  the  testes, 
ligation  of  the  cord,  or  ligation  of  the  vas  deferens? 

"6.  What  operation  would  you  advise  upon  females? 

"7.  At  what  age  would  the  operation  be  most  effective? 

"8.  Have  you  had  practical  clinical  experience  in  this  matter? 

"9.  Should  a  State  law  be  enacted  to  legalize  the  operation?  If  so,  what 
would  you  suggest  in  regard  to  such  a  law  ?  " 

Of  the  61  institutions  addressed — 25  American  and  36  foreign, 
including  those  of  Great  Britain,  France,  Germany,  Austria,  Switz- 
erland, Russia,  Finland,  and  the  Scandinavian  countries,  but  12  re- 
sponded :  9  American,  1  German,  1  Scotch,  and  1  English ;  and  of 
these  only  9  replies  were  definitive. 

While  all  agree  that  procreation  is  not  advisable — that  defect 
must  breed  defect — there  is  evident  cautiousness  in  advocating  asex- 
ualization in  all  grades,  but  a  consensus  as  to  the  necessity  being 
greatest  for  those  of  high  grade.  The  first  question  is  unanimously 
answered  "  none  "  ;  the  second  gives  an  average  of  80  per  cent.  The 
non-committal  tenor  of  the  replies  to  the  third  and  fourth  questions 
as  to  mental,  moral,  and  physical  effects,  evidences  the  limited  op- 
portunities that  exist  for  collecting  sufficient  data.  The  fifth,  sixth, 
and  seventh  replies,  as  to  the  modus  operandi  and  the  proper  age, 
are  more  explicit,  the  majority  favoring  testiectomy  in  the  male 
and  oophorectomy  in  the  female,  at  or  before  the  age  of  puberty. 

To  question  eight,  five  state  frankly  that  they  have  had  no  prac- 
tical experience,  and  the  others  give  rather  evasive  answers. 


ASEXUALIZATION.  1 93 

To  the  ninth — the  question  of  seeking  legislative  aid — three- 
fourths  give  unqualified  approval,  two  see  no  necessity,  and  one  is 
doubtful  of  success. 

The  limited  response,  especially  from  foreign  countries,  would 
indicate  either  timidity  in  expression  of  opinion,  or  that  ultra-conser- 
vatism that  is  often  the  safe-guarding  of  all  advance  movements ; 
nevertheless  it  is  most  fitting  that  this  preparation  for  carrying  out 
principles  which  science  and  experience  alike  dictate  for  the  ameli- 
oration of  imbecility,  should  have  been  accomplished  before  the  close 
of  the  century  that  had  witnessed  so  much,  both  of  the  initiation  and 
of  the  progress  of  the  work  among  mental  defectives.  Almost  a 
decade  of  experience  since  that  circular  was  issued  has  tended  to 
emphasize  the  subject  as  well  as  to  broaden  the  views  of  those  called 
to  consider  it,  so  as  to  encourage  the  hope  that  it  yet  may  receive 
the  seal  of  the  law. 

The  first  step  toward  securing  legislative  authorization  was  taken 
in  1901,  when  the  subject  was  thus  presented: 

To  the  Members  of  the  Senate  and  House  of  Representatives, 

Harrisburg,  Pa. 

Gentlemen  :  The  following  are  some  points  which  you  may  be 
able  to  use  in  considering  the  "  Bill  for  the  Prevention  of  Idiocy," 
which  was  brought  before  the  notice  of  the  Law  and  Order  Com- 
mittee, and  reported  favorably  by  them. 

The  very  serious  importance  of  this  measure,  not  only  for  the 
present  management  and  treatment  of  this  unfortunate  class  of  indi- 
viduals, but  for  the  prevention  of  their  increase  in  the  community, 
is  patent  to  everyone  who  has  carefully  studied  the  subject ;  it  should 
therefore  be  thoroughly  considered  in  the  spirit  of  seriousness  to  > 
which  it  is  entitled.  It  is  a  measure  first  for  the  good  of  the  public ; 
second,  for  the  benefit  of  the  individual.  Everyone  who  has  paid 
thoughtful  attention  to  this  question  knows  how  largely  the  element 
of  heredity  enters  into  the  complex  problems  of  degeneracy.  While 
we  cannot  lessen  the  number  of  already  existing  idiots,  we  can  do 
something  to  protect  our  successors  from  the  increasing  volume  of 
defectives.  It  must  be  remembered  that  these  idiots  must  always 
13 


194  CRANIECTOMY. 

be  dependents ;  they  can  never  be  self-supporting,  but  must  always 
be  the  wards  of  the  State  and  cared  for  in  her  almshouses  and  other 
institutions.  The  State  therefore  has  a  right  to  act  in  place  of  the 
parent,  and  also  to  take  measures  to  prevent  their  propagation. 

As  regards  the  individual :  The  effect  of  lessening  sexual  desire 
will  certainly  render  these  individuals  more  docile,  more  tractable, 
and  will  remove  a  powerful  incentive  to  evil,  both  as  regards  them- 
selves and  the  general  public.  Having  no  restraining  will  power,  it 
cannot  be  expected  that  they  will  restrain  themselves ;  they  will  act 
naturally  in  accord  with  their  abnormal  desires  and  appetites  at  any 
moment.  One  who  is  unacquainted  with  the  class  cannot  under- 
stand the  degree  to  which  this  vileness  extends,  or  the  evil  that  fol- 
lows from  it.  If  it  is  argued  that  the  operation  for  unsexing  makes 
them  less  vigorous  or  manly,  it  should  be  remembered  as  stated 
above,  that  this  class  must  necessarily  always  be  helpless  dependants 
and  non-supporting.  A  gelding  or  ox  loses  nothing  but  becomes  in 
every  respect  more  docile,  more  useful,  and  better  fitted  for  service. 

In  regard  to  the  operation  itself.  It  is  not  at  all  a  serious  one, 
and  in  the  bill  you  will  note  that  discretion  as  'to  the  operation  to 
be  performed  is  left  to  the  surgeon.  If  it  seems  desirable  that  the 
testicles  remain  for  the  sake  of  appearances,  the  severing  of  the  duct 
or  vas  deferens  is  in  itself  sufficient  to  secure  sterility,  and  if  the 
operation  is  performed  in  the  boy  before  semen  commences  to  be 
secreted,  the  testicles  will  merely  diminish  in  size,  and  become  in- 
active. This  operation  is  a  very  trivial  one ;  it  has  been  performed 
a  great  many  times  by  surgeons  often  without  ether  and  without 
pain  to  the  individual. 

It  is  very  important  that  you  should  carefully  separate  from  this 
subject  the  question  of  castration  of  criminals,  as  it  is  highly  essen- 
tial that  the  two  matters  be  kept  entirely  distinct.  This  treatment 
as  to  idiots  is  absolutely  an  independent  one,  and  should  not  be 
viewed  in  any  sense  as  a  punishment,  but  as  a  help  to  the  individual 
in  controlling  himself,  and  in  his  relations  to  the  public. 

The  idiot  girl  even  should  she  not  herself  seek  cohabitation,  is  at 
the  mercy  of  every  villain,  and  even  when  at  the  lowest  of  the  scale, 
without  any  intelligence  whatsoever,  may  produce  offspring  that  will 
be  necessarily  a  curse  to  society. 


ASEXUALIZATION.  1 95 

With  great  respect,  we  have  the  honor  to  be, 
Very  truly  yours, 

.De  Forest  Willard,  M.D., 
Clin.  Prof.  Orth.  Surg.  University  of  Penna. 
Surg.  Presbyterian  Hospital. 

Samuel  D.  Risley,  M.  D., 
Attending  Surg.   Wills  Eye  Hospital. 

Martin  W.  Barr,  M.D., 
Chief.  Phys.  Penna.  Training  School  for  Feeble 
Minded,  Elwyn,  Pa. 

This  appeal  was  approved  by  the  following  Act  of  Assembly: 

Whereas  :  Heredity  plays  a  most  important  part  in  the  transmis- 
sion of  idiocy  and  imbecility ; 

Therefore,  Be  it  enacted  by  the  Senate  and  House  of  Represen- 
tatives of  the  State  of  Pennsylvania  that  on  the  first  day  of  July 
after  the  passage  of  this  bill,  it  shall  be  compulsory  for  each  and 
every  institution  in  the  state  entrusted  with  the  care  of  idiots  and 
imbecile  children  to  appoint  upon  its  staff  at  least  one  skilled  neu- 
rologist and  one  skilled  surgeon  of  recognized  ability,  whose  duty 
it  shall  be  in  conjunction  with  the  chief  physician  of  the  institution 
to  examine  the  mental  and  physical  condition  of  the  inmates. 

If  in  the  judgment  of  this  committee  of  experts  and  the  board  of 
trustees  procreation  is  inadvisable,  and  there  is  no  probability  of  im- 
provement of  the  mental  condition  of  the  inmate,  it  shall  be  lawful 
for  the  surgeon  to  perform  such  operation  for  the  prevention  of 
procreation  as  shall  be  decided  safest  and  most  effective,  but  this 
operation  shall  not  be  performed  except  in  cases  that  have  been  pro- 
nounced non-improvable. 

After  passing  both  Houses,  this  Act,  returned  by  the  Governor 
for  the  correction  of  some  trifling  technicality,  was  unfortunately 
lost  and  thus  failed  to  become  a  law. 

Meanwhile  multiplied  instances  are  proving  the  necessity  of  some 
means  of  prevention. 

Dr.  F.  Hoyt  Pilcher,  of  the  Institution  for  Feeble  Minded  Chil- 
dren at  Winfield,  Kansas,  says :  "  Time  has  fully  justified  the  wis- 
dom of  this  departure  from  all  other  established  methods  of  treating 
the  base  and  abnormal  conditions  so  common  to  an  imbecile  mind." 


I96  ASEXUALIZATION. 

Much  distressed  by  debasing  habits  rife  among  the  children  of 
his  institution,  and  having  exhausted  every  means  of  reformation 
through  discipline,  he,  after  consultation,  castrated  58  boys,  with  a 
resulting  gain  in  almost  every  case  of  marked  improvement  both 
mental  and  physical.  His  board  of  trustees  sustains  his  action, 
thus: 

"  A  great  deal  has  been  said  in  the  political  press  and  medical 
journals  of  our  country  about  the  unsexing  of  .  .  .  boys  by  Super- 
intendent Pilcher,  the  political  papers  censuring,  and  the  medical 
journals  sustaining  him.  As  all  forward  steps  have  brought  criti- 
cism to  the  person  who  had  the  courage  to  take  them,  so  this  hu- 
mane act  has  brought  criticism  to  Doctor  Pilcher.  All  that  would 
be  necessary  to  convince  those  most  horrified  by  this  act  of  the  wis- 
dom of  it,  would  be  to  have  known  the  boys  before  and  after  the 
operation.  Those  who  are  now  criticizing  Doctor  Pilcher  will,  in 
a  few  years,  be  talking  of  erecting  a  monument  to  his  memory." 

Dr.  Everett  Flood,  superintendent  of  the  Hospital  for  Epileptics 
at  Palmer,  Mass.,  reports  26  cases  in  which  asexualization  was  per- 
formed, some  being  circumcised  at  the  same  time,  with  no  bad  re- 
sults. With  24  the  cause  for  operating  was  epilepsy  and  persistent 
masturbation.  One-half  were  under  fourteen,  two  over  twenty,  and 
the  remainder  about  fifteen  years  old,  the  mental  and  moral  condition 
being  good  in  2,  fair  in  9,  but  poor  in  the  others.  Observation  for 
some  years  after  operation,  noted  mental  condition  improved  in  only 
3  cases,  and  moral  condition  in  only  4 — 2  kleptomaniacs  reformed, 
one  who  was  salacious  improved,  and  one  who  was  solitary  acquired 
a  more  social  disposition.  The  temper  was  improved  in  all  but  4 
cases.  The  sexual  appetite  seemed  to  disappear  in  all  but  2  cases, 
and  appeared  in  these  only  periodically.  The  effect  upon  the  epi- 
leptics was  favorable ;  with  some  the  attacks  ceasing  altogether  or 
returning,  as  in  a  single  case,  after  immunity  of  two  years. 

Pfister  reports  116  women  operated  upon.  The  menopause  fol- 
lowed in  94.8  per  cent,  and  molimen  menstruate  in  30  per  cent. 
Sexual  desire  was  extinguished  in  52  per  cent. ;  diminished  in 
30  per  cent. ;  undiminished  in  26  per  cent.  Atrophy  of  the  uterus 
was  constant,  but  of  the  vagina  and  vulva,  less  frequent.  Atrophy 
of  the  mammary  gland  was  noted  in  29  women.     The  tendency  to 


Plate  XXXIV. 


Case  E. 
MONGOLIAN  TYPE. 


ASEXUALIZATION.  1 97 

obesity  was  increased.  For  some  time  after  the  operation,  the  dis- 
position was  changed  for  the  worse,  but  only  in  exceptional  cases 
was  the  change  permanent.  The  causes  for  operation  were  myoma, 
dysmenorrhea,  hysteria  and  hystero-epilepsy ;  cases  suffering  from 
the  first  named  receiving  most  benefit.  Results  show  18  improved, 
and  87  cured  by  the  operation.  My  own  experience,  although  lim- 
ited, has  been  decidedly  favorable ;  3  cases  of  oophorectomy  and  3 
of  testiectomy  have  resulted  in  improvement  mental,  moral,  and 
physical — especially  marked  in  the  boys. 

My  preference  in  operation  inclines  to  oophorectomy  in  the  female 
and  testiectomy  in  the  male,  although  for  a  time  the  temperature 
does  run  alarmingly  low.  If,  however,  there  is  objection  to  the  lat- 
ter, an  operation  harmless  and  almost  painless  is  vasectomy,  which 
is  less  heroic  and  is  said  to  be  quite  as  effective  as  castration.  Ob- 
servation shows  that  where  asexualization  is  performed  late  in  life, 
sexual  desire  is  not  abated,  whereas  it  is  practically  lost  if  the  opera- 
tion takes  place  in  early  childhood.  The  child  then  grows  stout  and 
acquires  a  large  frame.  There  is  no  hair  on  the  pubes  or  the  face, 
the  cheeks  become  round  and  prominent,  and  the  chin  is  apt  to  be 
double.  Boys  come  to  resemble  immense  women.  The  singing 
voice  also  is  that  of  a  woman  until  puberty  is  reached,  when  it  is 
found  to  be  an  octave  lower. 


CHAPTER  VIII. 

cretinism  and  myxcedema. 
Cretinism. 

Cretinism  is  so  closely  allied  to  idiocy  that  its  history  has  nat- 
urally been  considered  with  it  in  Chapter  II. 

Dating  from  remote  ages,  allusions  to  it  may  be  traced  through 
its  chief  associate  goitre ;  thus  Juvenal  says  :  "  Quis  tumidum  guttur 
miratur  in  Alpibus,"  and  Vitruvius :  "  Guttur  homini  tumescit  prae- 
sertium  apud  agricolas  Italise  Medullos  Alpinos."  Pliny  and  Strabo 
make  similar  reference,  and  these  goitrous  people  are  evidently  the 
same  class  as  the  present  cretins.  Paracelsus  associates  cretinism 
with  idiocy  thus  :  "  All  ye  goitred  people  are  more  ready  for  foolish- 
ness than  for  cleverness,"  and  further :  "  Strumosi  raro  sunt  sapien- 
tes ;  qui  et  cerebrum  ex  mineralibus  suum  habet  liquorem  sen  nutri- 
mentum ;  quia  illud  imperfectum  quoque  et  immaturum  ad  cerebrum 
ascendit,  inde  destriut  partem  memorise,  et  quoque  surdi  sunt ;  quia 
humor  mineralis  occludit  ames,  sed  lingua  et  naso  et  oculis  non 
nocet." 

The  origin  of  the  word  cretinism  is  uncertain.  Fodere  says  that 
it  is  derived  from  chretien — christian — growing  out  of  a  popular 
belief  that  the  cretin,  because  of  his  happy  disposition,  is  blessed  of 
heaven,  a  sentiment  akin  to  the  veneration  of  the  idiot  as  a  super- 
natural being.  Others  suggest  that,  descriptive  of  the  peculiar  com- 
plexion, it  is  possibly  derived  from  the  Latin  creta,  chalk,  found  also 
in  the  German  Kreidling  from  their  Kreide,  chalk. 

Indeed  appellations,  significant  of  speech  or  appearance,  are  fre- 
quent ;  such  as  lallen,  alluding  to  the  peculiar  voice ;  trotteln  in  Aus- 
tria, talken  in  the  Tyrol,  totteln  in  Salzburg,  and  fexen  in  Wurtem- 
berg.  They  are  also  spoken  of  by  some  writers  as  capots,  caffos, 
or  cagots,  and  there  are  various  local  appellations — the  gavas,  and 
semphiaggine  of  Italy  and  bovos  of  South  America.  In  Vallais 
cretins  are  divided  into  three  classes — the  highest  gauch,  the  middle 
grade  trissel,  and  the  lowest  tschengen. 


CRETINISM.  I99 

A  comparison  of  the  terms  used  in  various  countries  may  show 
the  derivation  of  the  word  cretin,  from  the  Latin  creatur,  and  its 
use  rather  that  of  compassion  or  endearing  pity,  such  as  is  expressed 
in  the  word  cretira  of  the  Romansch  and  creatura,  applied  univer- 
sally, in  Spanish  countries,  to  infants  or  to  young  children.  It  is 
singular  to  note  that  the  Germans  find  in  this  Latin  creatur  a  syno- 
nym for  their  geschbpf,  and  indeed  use  these  interchangeably  in 
speaking  of  cretins,  which  word  they  have  also  adopted.  Some 
writers,  however,  consider  that  it  is  applied  in  yet  another  sense 
descriptive  of  childishness  or  stupidity.  This  idea  is  confirmed  in 
the  fous  and  foulitre  of  Savoy  and  Piedmont,  and  in  the  dotteln  and 
totolas  of  Styria  and  Italy,  and  of  the  tontos  of  South  America. 

Cretinism  is  a  phase  of  idiocy  or  imbecility,  either  endemic  or 
sporadic,  characterized  by  stunted  growth, — the  usual  height  from 
three  to  four  feet,  never  exceeding  five ;  short,  thick  neck ;  large 
misshapen  head ;  hair  coarse  and  thick ;  tawny  skin — usually  coarse 
and  wrinkled ;  eyes  small  and  set  far  apart,  with  puffy  lids — strabis- 
mus not  infrequent ;  cheeks  swollen,  often  showing  red  patches ; 
broad  flat  nose,  distended  nostrils ;  thick  lips,  dribbling  viscid  saliva ; 
large  protruding  tongue,  with  papillse  markedly  hypertrophied ; 
teeth  imperfect,  usually  much  decayed.  The  cranium  is  brachy- 
cephalic — vertex  and  occiput  flattened — and  ears  malformed.  The 
limbs  are  short  and  misshapen,  and  the  gait  awkward,  waddling,  and 
uncertain.  Hands  large  and  spade-like,  with  flat  and  stumpy  fin- 
gers. Usually  there  is  a  lumbar  lordosis ;  the  abdomen  is  tumid, 
large,  and  pendulous,  as  are  the  mammae  in  the  female  and  the  ex- 
ternal genitals  in  the  male.  The  sexual  functions  are  often  abnor- 
mally increased  in  both  sexes,  but  impotence  may  exist.  Puberty  is 
delayed  often  beyond  the  twenty-first  year ;  menstruation  is  scanty, 
and  masturbation  frequent  in  both  sexes.  The  circulation  is  slug- 
gish, the  pulse  slow,  respiration  diminished  and  temperature  sub- 
normal. The  mentality  may  vary,  but  cretins  are  rarely  brighter 
than  low-grade  imbeciles ;  to  this  there  are,  of  course,  rare  excep- 
tions. (See  Chapter  XI.  Idiots  Savants.)  Speech  is  generally 
very  defective,  or  entirely  absent.  In  disposition,  cretins  are  very 
gentle  and  affectionate,  but  may,  when  roused,  become  violent. 
Their  vitality  is  low,  and  as  a  rule  they  do  not  live  beyond  the  age 
of  thirty. 


200  CRETINISM. 

The  essential  defect  of  the  cretin,  general  and  pronounced,  is  the 
atrophy  or  entire  absence  of  the  thyroid  gland  with  or  without  fatty 
tumors  in  the  supraclavicular  fossae ;  or  there  may  be  swelling,  and 
the  gland  increasing  in  size  may  develop  into  goitre. 

The  autopsy  reveals  the  walls  of  the  vesicles  infiltrated  with  em- 
bryonic tissue,  and  a  condition  of  chronic  thyroiditis  is  evident.  The 
connective  tissue  is  increased  throughout  the  body,  and  the  fat  also. 
The  sweat-glands  are  obstructed  by  epithelial  cells,  and  both  skin 
and  blood  exhibit  the  presence  of  much  mucin.  Whatever  varia- 
tions the  pathology  of  cretinism  may  reveal,  one  fact  is  constant, 
that  the  thyroid  gland  is  functionless  and  its  secretions,  therefore, 
lost  to  the  system.  Although  the  office  of  this  secretion  is  still  un- 
known, it  is  a  common  fact  well-worthy  of  note,  that  cretinism  and 
myxoedema  are  both  traceable  to  this  loss  and  so  well-established  is 
this  fact  that  I  have  long  inclined  to  the  opinion  that  these  condi- 
tions are  almost  identical,  there  being  a  difference  of  degree  rather 
than  in  kind. 

Wolfstein  says :  "  None  of  the  internal  secretions,  the  seminal 
fluid  excepted,  ranks  the  thyroid  in  potency."  Schiff  claims,  that 
the  nutrition  of  the  nervous  system  is  largely  dependent  upon  it,  and 
Horsley  considers  it  has  an  influence  in  the  formation  of  the  blood. 

Dr.  Kostl,  of  Austria,  thus  describes  the  cretin :  "  Man  does  with 
difficulty  recognize  in  the  idiot  not  a  fellow  being,  but  rather  a  slimy 
beast  or  at  most  a  monkey.  He  turns  away  from  him  with  fear, 
loathing,  and  horror,  rather  than  feeling  the  respect  and  self-deny- 
ing love  which  human  dignity  and  human  suffering  induce  and  need. 
Nothing  which  could  remind  of  the  beauty  and  harmony  of  the  crea- 
ture power  permeates  the  form.  It  is  certainly  the  same  stuff  we 
are  made  of;  the  different  parts  and  members  are  there,  of  which 
our  body  is  constituted,  but  they  have  remained  in  a  lower  stage  of 
development,  have  wasted,  been  deformed,  disfigured;  as  it  were, 
thrown  together  by  chance ;  mechanically  chained  to  each  other  with- 
out proportion;  an  animal  made  of  human  matter,  yet  below  the 
animal." 

Endemic  cretinism  is  found  in  almost  every  part  of  the  world,  but 
occurs  with  greatest  frequency  in  Europe;  it  is  seen  occasionally  in 
Asia,  Africa,  and  even  in  America.     In  Europe  it  is  met  with  in  the 


Plate  XXXV. 


Case  C. 


Case  B. 


CRANIECTOMY. 


CRETINISM.  20 1 

mountains  and  valleys  of  Switzerland — the  Alps,  the  Jura,  and  the 
Vosges,  and  in  the  neighborhood  of  Styria,  the  Tyrol  and  Salzburg, 
in  Savoy,  Piedmont,  Venetia,  Lombardy,  and  the  northern  slope  of 
the  Apennines. 

It  is  found  in  the  Austro-Hungarian  empire,  and  in  Germany,  and 
in  Spain  it  is  quite  common  on  the  southern  slope  of  the  Pyrenees, 
but  is  less  frequent  in  the  valleys  of  Auvergne,  France,  and  is 
seen  only  occasionally  in  Belgium.  In  Great  Britain  a  few  cases 
are  found:  in  Scotland,  on  the  east  side  of  Arran  and  on  the  east 
coast  of  Fife;  and  in  England  in  the  dales  between  Yorkshire  and 
Lancashire — at  one  time  it  existed  in  Somerset,  but  is  now  extinct 
there.  In  Sweden,  Denmark,  and  Norway  endemic  cretinism  does 
not  exist.  In  Russia  it  is  found  in  the  valley  of  Ojat  and  also  in 
Siberia.  In  Asia  the  endemic  form  of  cretinism  is  seen  in  the  Him- 
alaya mountain  region,  in  some  of  the  provinces  of  Cochin-China, 
Burmah,  and  in  the  north  of  China  proper.  It  is  also  found  in 
Madagascar.  In  South  America  the  disease  is  known  to  occur 
along  the  course  of  the  Magdalena  river,  and  in  North  America  it 
has  been  seen  in  California  and  in  certain  parts  of  Vermont  and 
Massachusetts. 

This  widespread  association  of  cretinism  with  localities,  essentially 
similar  although  in  countries  remote — the  slopes  of  high  mountain 
ranges,  close  shut  in  valleys  or  low-lying  marshy  regions — in  all 
of  which,  qualities  deleterious  or  disadvantageous  impregnate  air 
and  water  tending  to  establish  unhealthy  conditions,  has  led  to  a 
general  belief  in  the  influences,  climatic  and  geologic,  of  such  locali- 
ties as  a  primary  cause  in  the  production  of  endemic  cretinism ;  a 
cause  which  the  intermingling  and  quadrupling  of  inherited  weak- 
nesses— a  natural  result  of  isolated  communities — has  intensified. 

True  there  are  many  sporadic  cases  not  traceable  to  such  influ- 
ences, approximating  in  all  essential  features  very  closely  to  endemic 
cretinism,  and  it  is  quite  possible  that  various  nervous  conditions 
might  so  commingle  and  unite  through  successive  generations  as  to 
create  influences  akin  to  those  of  locality,  producing  similar  but  not 
identical  results.  The  isolated  examples  of  cretinism  that  are  now 
found  in  this  country  and  in  England,  can  hardly  be  called  true  cretin- 
ism, as  lacking  its  intensity  of  coarseness  and  stupidity.  These  are, 
therefore,  better  classed  as  demi-cretins,  or  cretinoids. 


202  CRETINISM. 

Although  Plater,  Forest,  Simler,  Wagner  and  others  had  given 
descriptions  of  the  cretin,  more  or  less  voluminous,  it  was  quite  late 
in  the  eighteenth  century  before  physicians  began  to  study  condi- 
tions. Troxler  says :  "  The  priests  of  all  classes,  the  good  Samari- 
tans as  well  as  the  ambitious  Levites  of  the  theological  faculty,  the 
pedagogues  and  diplomats,  and  particularly  the  farmers  of  our  22 
districts  from  A  to  Z,  pass  by  the  cretin  because  they  are  accus- 
tomed to  the  sight  and  are  weaned  from  pity." 

Wolfgang  Hofer,  court  physician  in  Vienna,  1675,  was  the  first 
to  give  a  scientific  disquisition  upon  cretinism ;  later  the  efforts  of 
Guggenbiihl,  1842,  reduced  theory  to  practice.  The  work  of  the 
Abendberg  was  not  only  to  ameliorate  conditions,  but  to  demonstrate 
needs,  and  following  close  upon  this  demonstration,  came  experi- 
ments in  treatment. 

To  Schiff  it  occurred  that  the  transplanting  of  the  thyroid  gland 
entire  from  some  animal  might  restore  lost  function ;  this  not  bring- 
ing the  success  expected,  various  experiments  were  made  by  Victor 
Horsley,  Murray  Howitz,  Hector  MacKenzie  and  others,  and  the 
subcutaneous  injection  of  the  thyroid  juice  was  tried  with  better 
results.  Subsequently  the  administration  of  doses  of  the  raw  gland 
itself,  preferably  that  of  sheep,  threw  fresh  light  upon  the  subject. 
The  patient  thus  fed  began  to  grow  taller,  the  eyes  lightened  and 
widened,  the  lips  more  approaching  the  normal  restrained  the  tongue 
within  the  mouth,  new  teeth  appeared,  the  complexion  cleared,  the 
abdomen  receded,  the  hair  became  finer,  and  with  approach  to  nor- 
mal physical  conditions,  the  mind  brightened  and  the  child  became 
gradually  a  more  intelligent  being. 

This  success  led  to  modifications  in  method  of  administering  the 
remedy,  the  dried  extract  being  now  usually  given  in  tabloid  form. 
To  prevent  unpleasant  effects,  the  dose  should  be  regulated  in  accord- 
ance with  each  case,  which  must  be  studied  individually  by  a  physi- 
cian, as  over  doses  give  rise  to  alarming  symptoms — rise  of  tem- 
perature, rapid  pulse,  diarrhoea,  emaciation,  faintness,  and  even  fatal 
collapse.  The  treatment  must  be  perpetual,  otherwise  relapses  will 
occur.  Beginning  with  one  grain  daily  the  dose  is  gradually  in- 
creased to  six  grains,  reducing  as  improvement  becomes  permanent. 


myxcedema.  2c>3 

Myxcedema. 

Myxoedema  is  a  constitutional  affection  due  to  atrophy  of  the 
thyroid  gland,  and  infiltration  of  the  subdermal  tissues  with  a  mucin- 
like  substance,  characterized  by  slow  but  steady  increase  of  the  bulk 
of  the  entire  body,  swelling  of  the  skin — which  does  not  pit  on 
pressure — show  speech,  irritability,  marked  mental  deterioration,  with 
delusions  and  suspicions  bordering  on  insanity,  obstinacy,  and  not 
infrequently  violence.  The  manifestations  of  myxcedema  resemble 
those  of  cretinism,  to  which  it  is  closely  allied.  In  the  former,  how- 
ever, the  symptoms  are  much  more  pronounced,  although  there  are 
present  the  same  chalky  complexion,  with  the  reddish  patches  on 
the  cheeks,  the  swollen  eyelids,  broad  flat  nose,  large  mouth,  thick- 
ened lips,  dry  brittle  hair,  and  swollen  hands  and  feet. 

Myxcedema,  first  described  by  Sir  William  Gull,  in  1873,  has 
been  variously  elaborated  since  by  Ord,  Charcot,  Horsley,  Virchow 
and  others  and  summed  up  in  an  exhaustive  report,  1888,  of  a 
committee  of  the  Clinical  Society  of  London,  thus :  "  There  is 
strong  evidence  that  myxcedema,  sporadic  cretinism,  endemic  cretin- 
ism, cachexia,  strumipriva,  and  the  operative  myxcedema  of  ani- 
mals, are  species  of  one  genus,  and  that  the  one  pathological  fact 
common  to  all  these  conditions  is  the  occurrence  of  morbid  proc- 
esses, involving  destruction  of  the  thyroid  gland." 

The  diagnosis  can  generally  be  made  without  difficulty.  Occa- 
sionally, however,  it  may  be  confounded  with  the  adiposis  dolorosa 
of  Dercum,  or  with  akromegaly. 

The  prognosis  is  unfavorable,  although  there  may  be  possibility 
of  amelioration.  Death  may  result  from  the  malady  itself,  or  more 
frequently,  from  some  intercurrent  disease,  such  as  tuberculosis, 
brain  or  kidney  trouble. 

Post-mortem  examination  shows  the  thyroid  gland  atrophied  or 
much  diminished  in  size,  or  it  may  have  degenerated  into  a  fibrous 
mass.  Increase  of  mucin  is  noted  and  always  an  excessive  deposit 
of  subcutaneous  fat. 

The  treatment  is  the  same  as  in  cretinism — the  dried  extract  of 
the  thyroid  gland,  preferably  in  tabloid  form. 


CHAPTER   IX. 

MICROCEPHALIA  AND  HYDROCEPHALUS. 
MlCROCEPHALUS. 

Among  the  varied  forms  of  cranial  abnormality,  microcephalus  is 
as  interesting  as  it  is  rare.  Not  alone  because  of  the  peculiar  shape 
and  size  of  the  head,  but  because  of  the  problem  that  physiology 
and  psychology  together  have  yet  to  solve,  viz.,  the  relation  of  size 
to  capacity,  or  the  bearing  that  the  actual  size  of  the  brain  has  upon 
mental  power. 

While  there  is  abundant  proof  that  the  head  of  a  typical  idiot  is 
generally  smaller  than  a  normal  person,  and  although  there  is  an 
established  minimum  (Gall  says  13  inches  in  circumference)  below 
which  idiocy  must  of  necessity  exist;  it  yet  remains  to  be  proven 
that  the  mere  size  of  the  head,  except  in  the  extremes  of  micro- 
cephalus and  hydrocephalus,  gives  absolute  or  definite  indication  of 
capacity  or  of  intelligence.  Esquirol,  Pritchard,  and  Jovill  unite 
in  the  opinion  that :  "  No  constant  relation  exists  between  the  gen- 
eral development  of  the  cranium  and  the  degree  of  intelligence." 
Voisin  on  the  contrary  gives  a  regular  scale  of  direct  relation,  ac- 
cording to  which,  head  circumference  from  18  to  18.5  inches,  though 
small,  may  permit  of  intellectual  processes ;  a  circumference  from 
14  to  17  inches  is  too  small  for  ordinary  intelligence,  while  11  to  13 
inches  is  the  limit  where  idiocy  must  necessarily  begin. 

Phrenologists  and  evolutionists  have  each  in  turn,  with  about 
equal  success,  seized  upon  microcephalus  in  order  to  prove  their 
favorite  theories.  The  failure  of  craniectomy  in  its  effort  to  bring 
about  the  growth  of  a  brain  locked  in  an  osseous  cavity,  might  also 
go  to  disprove  much  that  phrenology  would  claim.  Gratiolet  re- 
futes the  theories  of  the  evolutionists  by  noting  the  difference  in 
convolutions  and  in  parallel  fissures,  in  comparing  the  brain  of  an 
ape  with  that  of  a  microcephal ;  showing  that  even  "  in  the  depth  of 
his  degradation,  the  brain  of  the  microcephal  presents  human 
characters  often  less  voluminous  and  less  convoluted  than  those  of 

204 


Plate  XXXVI 


MICROCEPHALUS.  205 

the  orang-outang  or  the  chimpanzee.  They  do  not  become  identical ; 
the  microcephal  however  low  he  may  be,  is  not  a  beast,  but  a 
diminished  man."  This  is  further  emphasized  by  Giacomini  in  his 
larger  monograph — the  most  complete,  says  Dr.  Ireland,  in  any 
language :  "  Microcephaly  cannot  be  utilized  in  favor  of  the  theory 
of  descent,  for  it  represents  no  historical  period  in  the  development 
of  man." 

In  one  of  my  cases,  the  resemblance  to  a  monkey  in  climbing,  leap- 
ing, and  general  movements,  as  well  as  in  mischievous  habits  and 
powers  of  imitation,  is  quite  as  remarkable  as  that  of  the  goose,  the 
sheep,  the  bird,  and  the  rabbit-man  reported  by  Lombroso.  Yet, 
while  possessing  human  affections  and  emotions,  he  is  also  so  far 
below  the  ape  in  mental  powers — as  evinced  in  the  ape's  capacity 
for  self-help  and  self-protection — that  I  am  inclined  to  regard  the 
approximation  as  simply  a  freak  of  nature,  such  as  one  meets  in  the 
orchid,  the  dioncea  muscipula,  and  other  forms  of  plant  life.  One 
can,  however,  readily  see  how  the  Darwinian  theory  has  caused  at- 
tention to  be  directed  to  this  special  form  of  idiocy. 

Regarding  brain  weights,  Ireland  in  his  exhaustive  chapter  on 
microcephalus  has  gathered  some  valuable  data.  Thus  he  finds  San- 
der reporting  as  the  lightest  on  record,  a  microcephalic  brain  weigh- 
ing 170  gm. — about  6  oz.,  the  heaviest  on  record  being  that  of  Turg- 
enieff,  the  Russian  novelist,  which  weighed  71  oz. ;  Cuvier's  brain 
weighed  58.3  oz. ;  Napoleon's,  53  oz.,  and  Gambetta's,  40.9  oz. 

While  comparing  these  with  the  normal  average  brain  weight — 
man  from  40  to  52.5  oz.,  and  woman  35  to  37.5  oz. — we  yet  are 
not  prepared  to  insist  that  weight  of  brain  does  always  tend  to  pro- 
duce weighty  intellect,  as  it  is  certain  that  some  very  heavy  brains 
have  been  associated  with  what  is  known  as  heavy  dullness. 

In  the  interesting  comparison  of  microcephals  which  Ireland  cites 
from  Cardona  of  Milan,  we  find  excellent  proof  that  neither  size 
nor  weight  necessarily  sets  the  limit  of  intelligence. 

Antonia  Grandoni,  aged  forty-one  years,  height  52  inches,  and 
weighing  66  pounds,  although  an  imbecile,  was  one  of  the  brightest 
microcephals  known — sight  good,  hearing  quick,  taste  and  smell 
exquisite,  with  excellent  memory  for  persons,  places,  and  past  events. 
Her  sense  of  time  and  rhythm  must  have  been  good,  as  she  sang, 


206  MICROCEPHALIA. 

played  well  on  the  cymbals,  and  was  a  graceful  dancer.  Her  head 
measurements  taken  during  life  were :  External  circumference,  15 
inches ;  antero-posterior  diameter,  5  inches  4  lines ;  and  biparietal, 
7  inches  10  lines. 

The  skull  of  Cioccio,  measuring  13  inches  4  lines  external  circum- 
ference ;  antero-posterior  diameter  4  inches  3  lines ;  biparietal  3 
inches  10  lines — showed  on  the  other  hand,  a  brain  larger  than 
Grandoni's ;  yet  he  was  a  profound  apathetic  idiot.  In  comparison 
with  eleven  other  microcephals,  the  weights  of  whose  brains  ranged 
from  10  to  20  ounces,  not  one  of  these  equalled  in  intelligence 
Grandoni,  whose  brain  weighed  also  10  ounces.  A  comparison  of 
the  heads  of  normal  people,  giving  similar  results,  is  interesting  as 
showing  the  parallel  lines  of  genius  and  imbecility,  for  there  are  not 
lacking  examples  of  talent  and  intellect  associated  with  crania  below 
the  average  normal.  Such  were  Descartes,  Schuman,  Donizetti,  and 
Shelley. 

Measurements  of  the  skull,  recently  discovered  during  the  restora- 
tion of  a  church  in  Hannover,  of  the  philosopher  Leibnitz  are  inter- 
esting in  this  connection.  As  presented  by  Waldemyer  to  the  Prus- 
sian Academy  of  Sciences,  the  cranial  cavity  measuring  86.7  cubic 
inches  indicates  a  brain  rather  below  the  average  normal  size ;  which 
must  have  weighed  not  more  than  44  ounces.  The  contour  of  the 
skull  indicating  Slavic  origin  is  also  of  interest,  for  passing  from 
individuals  to  races  we  find  artificial  microcephaly  or  head  binding 
a  custom  with  many.  Mentioned  by  Strabonius  and  Hippocrates,  it 
was  also  common  among  the  Slavs,  Anglo-Saxons  and  Celts,  and 
the  ancient  Peruvians,  and  even  in  the  present  century  has  been 
practiced  by  some  tribes  of  North  American  Indians,  by  peasants 
in  the  north  of  Europe,  and  of  Brittany  and  Normandy  notwith- 
standing the  efforts  of  the  governments  to  repress  it. 

My  attention  has  recently  been  called  to  a  Scandinavian,  an  erratic 
musical  genius,  who  ascribed  his  superior  intelligence  to  such  com- 
pression of  his  head  in  childhood. 

The  Peruvians  with  an  average  brain  weight  of  40.1  ounces,  in 
an  advanced  state  of  civilization,  notwithstanding  the  disadvantage 
resulting  from  artificial  microcephaly — which  as  researches  show 
must  have  been  a  practice  habitual  and  widespread — placed  in  com- 


MICROCEPHALUS.  207 

parison  with  the  large-headed  negroes  (a  race  unquestionably  back- 
ward and  many  in  a  condition  of  barbarism)  present  a  view  wider 
than  is  possible  to  gain  from  any  accumulation  of  individual  cases. 
Such  view  taken  in  connection  with  the  condition  of  other  micro- 
cephalous people,  would  tend  to  confirm  the  idea  that  within  ordinary 
limit,  intelligence  is  not  dependent  upon  weight  or  size,  so  much  as 
upon  quality  and  texture  of  brain,  and  above  all  upon  nutrition. 

The  study  of  microcephalus  brings  out  some  interesting  historical 
facts. 

Microcephalic  heads  are  portrayed  on  Egyptian  monuments,  both 
in  sculpture  and  in  painting,  and  two  statues  of  microcephals  have 
been  found  in  Rome. 

Castelli  alludes  to  endemic  microcephalus  as  occurring  among  the 
Asiatics,  the  Caribbean  tribes,  and  the  Aztecs ;  indeed,  only  a  few 
years  ago,  two  examples  of  the  latter,  the  well-known  "  Aztec  chil- 
dren," who  were  undoubtedly  idiotic,  were  exhibited  both  in  Europe 
and  America. 

The  etiology  of  microcephalus  is  obscure ;  indeed,  investigations 
and  consequent  gathering  of  data  have  been  too  limited  to  form  a 
basis  for  definite  opinion  on  a  subject  upon  which  pathology  thus 
far  has  thrown  but  little  light.  Kelbs  thought  it  might  be  induced 
by  hour-glass  contraction  of  the  uterus  on  the  child's  head,  a  view 
that  lacks  confirmation.  At  one  time  it  was  believed  that  prema- 
ture closure  of  the  fontanel  tended  to  dwarf  the  growth  and  prevent 
the  expansion  of  the  brain,  but  this  supposition,  abandoned,  has 
given  place  to  the  now  commonly  accepted  view  that  the  lack  of 
brain  development  is  not  the  result,  but  the  cause,  of  premature  ossi- 
fication; that  it  is  the  brain  that  shapes  the  skull,  and  not  the  skull 
that  moulds  the  brain. 

This  is  confirmed  by  Langdon  Down,  who,  from  his  observation 
of  the  crania  of  200  idiots,  is  convinced  that  the  deviations  of 
the  cranium  have  been  rather  a  sequence  of  circumstances  arresting 
the  development  and  growth  of  the  brain,  than  the  result  of  prema- 
ture ossification  of  the  sutures ;  indeed,  he  goes  on  to  say  that  the 
only  instance  of  ossification  that  he  ever  met  with  was  in  a  macro- 
cephal. 


208  HYDROCEPHALUS. 

True  microcephals  are  either  mutes,  or  semi-mutes  with  limited 
vocabulary,  unable  to  formulate  any  but  the  simplest  sentences. 
These  are  sluggish,  sometimes  absolutely  helpless;  or  else  excitable, 
restless,  with  no  power  of  continuous  attention,  are  yet  extremely 
imitative,  resembling  monkeys  in  this  as  also  in  the  character  of 
their  movements.  The  sexual  instinct  is  feeble  or  absent.  All  micro- 
cephals have  narrow  receding  foreheads  and  flat  occiputs.  The 
fontanel  closes  prematurely,  usually  before  the  fifth,  and  rarely  later 
than  the  sixth,  month.    The  brain  weight  also  is  much  below  normal. 

According  to  Shuttleworth :  "  The  prognosis  may  be  said  to  be 
(generally  speaking)  favorable  or  otherwise,  in  proportion  to  the 
size  of  the  head.  With  heads  under  18  inches  in  circumference, 
the  manifestation  of  mental  power  is  usually  so  small  as  to  come 
under  the  category  of  idiocy ;  between  18  and  19  inches  the  case 
may  be  designated  as  imbecile;  and  from  19  to  20  inches,  is  not 
an  uncommon  measurement  in  cases  of  mere  '  feeble-mindedness.' " 
He  thinks  there  is  hope  for  improvement,  especially  for  the  higher 
grades  of  this  type,  and  cites  a  case  that  he  had  under  training  for 
four  years,  a  boy  whose  head  circumference  increased  during  that 
time  from  19  to  20.5  inches.  My  experience  confirms  this  view,  as 
I  have  found  improvement  limited  but  possible  in  cases  of  micro- 
cephalic imbeciles,  but  the  majority  of  cases  coming  under  my  ob- 
servation have  belonged  to  the  idiot  class  where  improvement  was 
necessarily  circumscribed  to  the  mere  gaining  of  habits  of  self-help 
and  cleanliness.  Few  microcephals  attain  the  twenty-first  year;  hav- 
ing little  or  no  resisting  power,  they  are  liable  to  fall  an  easy  prey 
to  the  diseases  of  childhood  or  to  succumb  in  early  youth  to  tuber- 
culosis. 

Hydrocephalus. 

Hydrocephalus  (udcop,  water;  xeyolrj,  the  head)  is  a  diseased  con- 
dition resulting  in  a  superabundance  of  fluid  in  the  intra-cranial 
cavity,  either  between  the  dura-mater  and  the  pia-mater,  known  as 
external  hydrocephalus ;  or  in  the  ventricles  themselves,  distending 
them  to  great  size,  often  infiltrating  the  white  substance  as  well. 
This  latter  condition  of  internal  hydrocephalus,  which  must  be  diag- 
nosed mainly  by  exclusion,  is  often  not  discernible  until  after  death. 

Hack  Tuke  reports  a  case  in  which  hydrocephalus  was  unsus- 


HYDROCEPHALUS.  200, 

pected  during  life,  but  at  the  necropsy  7  ounces  of  fluid  were  dis- 
covered in  the  lateral  ventricles  and  2  ounces  in  the  sac  of  the 
arachnoid. 

Most  frequently  congenital,  hydrocephalus  develops  before  or  soon 
after  birth,  more  rarely  between  the  first  and  seventh  year,  or  it 
sometimes  appears  as  a  sequel  to  non-tubercular  meningitis.  In  its 
pronounced  form  it  is  easily  recognizable,  the  skull  being  distended 
and  of  peculiar  shape — rounded  in  front  and  flattened  behind,  the 
transverse  and  the  antero-posterior  measurements  being  practically 
equal ;  the  widest  circumference  is  usually  at  the  temples.  The 
large,  bulging  fontanel  is  seen  often  up  to  the  sixth  year,  as  is  also 
the  defective  ossification  of  the  edges  of  the  cranial  bones.  The 
superficial  veins  of  the  scalp  are  much  dilated  and  very  prominent. 
The  eyes  prominent  and  frequently  down-cast,  are  partially  covered 
by  the  lids ;  in  some  cases  there  is  nystagmus  and  there  is  often  de- 
cided deafness.  At  times,  as  the  fluid  increases  the  patient  gives 
utterance  to  a  peculiar  scream  known  as  the  "  hydrocephalic  cry." 
The  body  is  generally  puny  and  dwarfed,  there  is  a  peculiar  "  top- 
heavy  "  gait,  and  often  a  complication  of  epilepsy  is  noted. 

In  diagnosing,  hydrocephalus  should  not  be  confounded  with  hy- 
pertrophy of  the  brain,  which  is  a  much  rarer  condition.  The  exces- 
sive circumference  of  the  head  at  the  temples  and  the  distance  be- 
tween the  eyes  observable  in  the  former,  do  not  exist  in  the  latter, 
and  are  distinguishing  marks. 

The  prognosis  is  not  favorable  in  congenital  cases.  Improvement 
is  possible  where  the  form  is  external,  but  internal  hydrocephalus, 
vitiating  the  very  structure  of  the  brain  as  it  does,  is  naturally 
always  associated  with  marked  mental  deficiency.  Children  so 
affected  are  generally  of  middle  or  low-grade — idiot  or  high-grade 
cases  being  exceptions.  External  hydrocephalus  is  not  so  grave. 
Indeed  in  rare  cases  where  it  occurs  late  in  life,  the  physical  signs 
are  not  so  marked  nor  is  the  mentality  necessarily  greatly  affected, 
although  there  may  be  more  or  less  eccentricity. 

It  is  related  of  Cardinal  N.,  a  pronounced  hydrocephal,  who  in 
spite  of  the  disease  lived  for  over  thirty  years,  that  his  brain  after 
death  was  found  floating  in  112  -J-  ounces  of  water. 

14  ... 


2IO  HYDROCEPHALUS. 

There  have  been  many  experiments  in  treatment — surgical  and 
medical ;  inunctions  of  mercury  and  blisters  applied  to  the  shaved 
head  and  bandages  compressing  it,  but  these  have  not  proved  en- 
couraging. Training  and  treatment — physical  and  mental — includ- 
ing regular  exercise,  saline  baths,  massage,  careful  diet,  rest  and 
occupation  regularly  alternating,  are  all  that  can  be  depended  upon 
to  build  up  mind  and  body,  and  retard  the  progress  of  the  disease. 


CHAPTER   X. 


EPILEPSY. 


Epilepsy,  as  tmdefinable  as  it  is  baffling,  may  yet  be  described  as 
an  imperfect  or  an  enfeebled  condition  of  certain  nerve  centers  pro- 
ducing an  insufficient  or  an  ill-regulated  supply  of  nervous  energy 
which  is  given  off  in  explosions  at  irregular  intervals ;  evidenced  in 
temporary  suspension  of  motor  coordination,  in  convulsive  move- 
ments, ordinarily  associated  with  loss  of  consciousness — total  or  par- 
tial— and  often  followed  by  general  prostration  (more  or  less  ex- 
cessive or  prolonged)  of  the  entire  nervous  system,  tending  to  a 
gradual  but  certain  diminution  and  degeneration  of  mental,  moral 
and  physical  powers.  Among  the  most  ancient  of  recorded  diseases 
— coeval  almost  with  the  history  of  man — epilepsy,  like  a  haunting 
shadow,  has  through  ages  dogged  the  footsteps  of  successive  gen- 
erations. In  every  clime,  among  all  races,  through  all  nations  it 
has  left  its  trace  in  palace  and  in  hovel,  for  no  class  is  exempt  from 
it.  Time,  which  has  modified  so  much,  makes  no  change  here.  Hip- 
pocrates' description  is  to  us  of  to-day  what  it  was  to  the  ancient 
Greeks,  and  the  victim  sends  forth  the  same  cry,  falls  and  wallows 
foaming  now,  as  he  did  of  old  at  the  feet  of  the  Great  Physician. 
Researches  into  the  subject  of  cause  and  cure  through  a  period  of 
3,000  years  have  resulted  only  in  revealing  a  hydra-headed  monster, 
until  physician  and  philanthropist,  scientist  and  layman,  are  alike 
tempted  to  exclaim  with  Sysyphus :  "  Mine  is  at  most  but  an  ever- 
lasting hope !  "  An  exhaustive  study  of  250  cases  out  of  some  800 
under  observation,  but  verifies  to  me  the  axioms  of  the  past  and  I 
find  no  warrant  for  departing  from  the  dictum  of  Hippocrates : 
"  The  prognosis  in  epilepsy  is  unfavorable  when  the  disease  is  con- 
genital, where  it  continues  to  manhood  or  where  it  occurs  in  an 
adult.  We  may  attempt  to  cure  the  young,  but  not  the  old."  "  May 
attempt,"  he  says,  but  I  find  nothing  to  justify  the  hope  of  ultimate 
and  permanent  cure  even  through  a  radical  change  of  life  and  en- 
vironment.    No  there  is  no  cure.     Epilepsy  is  due  to  a  something 


212  EPILEPSY. 

so  subtle  and  elusive  that  it  has  so  far  escaped  us ;  a  poison  so  to 
speak,  for  which  we  have  yet  to  find  an  antidote.  The  evil — like 
mental  defect  with  which  it  is  almost  invariably  associated — once 
developed  clings,  ready  for  reappearance  upon  the  slightest  provok- 
ing cause;  or  will  later  be  found  again  in  that  period  of  reversion 
to  original  type  popularly  known  as  second  childhood.  My  experi- 
ence shows  a  patient  immune  from  seizures  for  three  years,  during 
which  time  treatment  and  regimen  were  continued — for  I  never  con- 
sidered him  cured — dying  in  a  spasm  before  I  could  reach  him, 
although  living  in  the  same  house.  Epilepsy  with  no  apparent  ex- 
citing cause,  but  traceable  to  convulsions  in  infancy,  developed  in  a 
patient  of  sixty  years  of  age ;  and  in  yet  two  other  cases  there  was 
a  reappearance  of  spasms  after  cessation  of  19  and  30  years  respec- 
tively. The  experience  of  many  physicians  would  doubtless  prove 
these  not  exceptions,  but  typical  cases. 

Where  epilepsy  appears  late  in  life  without  apparent  cause,  inves- 
tigation almost  unfailingly  reveals  infantile  convulsions,  often  so 
slight  as  to  have  been  overlooked  or  forgotten  by  the  mother.  I  am 
confident  that  a  large  proportion  of  the  spasms  of  early  infancy  are 
of  this  character,  due  in  large  measure  to  the  influences  of  heredity, 
the  combination  and  concentration  of  varied  neuroses  tending  to 
produce  and  to  intensify  epilepsy.  It  is  possible  that  merely  a  high- 
strung,  over-wrought  nervous  condition  of  one  ancestor  may  com- 
bine with  phthisis,  neuralgia,  migraine  or  hysteria  to  produce  the 
same  unfortunate  result  as  would  the  combination  of  any  two  of 
these,  or  again  of  any  one  with  insanity  or  imbecility.  One  would 
naturally  suppose  that  an  unwritten  law  would  prevent  intercourse 
of  epileptics  and  therefore  forbid  or  at  least  deter  direct  transmis- 
sion of  the  malady,  yet  records  of  facts  to  the  contrary  are  not  lack- 
ing. Hammond  in  a  study  of  171  epileptics,  finds  heredity  a  cause 
in  45 — 21  of  these  proving  direct.  Echeverria  gives  26  per  cent, 
of  306,  as  descendants  of  epileptic  parents.  Delasiauve  found  the 
same  in  33  out  of  300  cases,  and  Herpin  10  in  68  cases. 

In  the  researches  of  Boucher,  Cazanveilh  and  Martin,  no  less  than 
78  children  are  noted  as  the  progeny  of  19  epileptic  parents.  I  find 
as  many  as  17  with  such  parentage,  and  one  boy  with  an  epileptic 
grandmother  had  a  brother  and  several  aunts  and  uncles  all  sim- 


Plate  XXXVII. 


/jc^H 


Case  B. 
CRETINOIDS. 


EPILEPSY.  213 

ilarly  afflicted.  On  the  other  hand,  Osier  and  Marie  find  very  few 
instances  of  direct  transmission.  Hamilton  says  that  fully  50  per 
cent,  of  his  980  cases  are  attributable  to  heredity.  Gowers  gives 
35  per  cent.,  and  the  56  per  cent,  of  my  table  coincides  with  Sprat- 
ling's  record  in  1,100  cases.  The  age  period  presented  in  my  table 
gives  further  confirmation  of  the  congenital  theory.  Reading  by 
hemi-decades,  we  find  167,  66  per  cent,  of  these  cases  developing 
epilepsy  in  infancy  between  birth  and  the  fifth  year,  while  all  but 
the  34  of  unrecorded  ages  are  previous  to  or  during  the  period  of 
puberty.  Nothnagel  also  finds  it  most  common  between  the  ages  of 
7  and  17  years.  Hasse,  Gowers  and  Spratling  find  over  75  per  cent, 
developing  before  the  twentieth  year,  and  this  large  proportion  is 
confirmed  in  the  experience  of  Landon  Carter  Gray.  These  statis- 
tics are  most  significant  as  pointing  to  that  period  of  life  when 
hereditary  influences  are  most  naturally  manifested. 

Intemperance  of  parents  has  also  been  adduced  as  a  prolific  cause 
of  epilepsy.  Echeverria  in  an  examination  of  572  epileptics,  children 
of  persons  addicted  to  drink,  found  that  257  could  be  attributed 
directly  to  the  habits  of  the  parents,  while  in  6y  other  cases  there 
was  a  complication  of  syphilis  and  alcoholism.  Moeli  says  that  of 
Germans  affected  with  delirium  tremens,  from  30  to  40  per  cent, 
are  epileptics.  Hippolyte  Martin,  among  150  insane  epileptics, 
found  83  with  a  paternal  history  of  intemperance.  Only  15  of  my 
250  cases  of  imbecile  epileptics  had  such  history. 

Syphilis  in  parents  may  be  accounted  less  a  predisposing  than  an 
actual  cause,  the  epilepsy  being  the  direct  outcome  of  the  local 
cerebral  disturbance.  I  find  it  in  only  2  cases,  and  Echeverria  in 
only  7,  of  his  618  cases. 

Among  exciting  causes  I  find  traumatism  most  frequent — falls, 
blows  and  wounds,  occurring  for  the  most  part  before  the  tenth  year 
to  the  number  of  50 ;  other  exciting  causes  being  in  21  cases,  injuries 
to  mother  during  gestation;  in  10,  the  result  of  difficult  dentition; 
and  acute  sicknesses — gastro-intestinal  disturbances,  eruptive  fevers, 
etc.,  and  above  all  that  fruitful  source  of  all  ills,  malnutrition — fill 
out  the  rest. 

There  has  been  a  question  as  to  sex  predisposition  to  epilepsy. 
Nothnagel,  Herpin  and  Reynolds  find  no  difference  in  the  number 
of  males  and  females  attacked.     Sieveking  and  Gowers  find  females 


214 


EPILEPSY. 


in  excess,  while  the  statistics  of  Althaiis,  Boyd,  Osier  and  Gray- 
show,  as  do  my  own,  males  in  larger  proportion. 

The  following  table  presents  in  condensed  form  the  relative  sex 
statistics,  and  the  age  period  of  appearance  as  far  as  obtainable, 
together  with  the  etiology,  classifying  the  various  heredities  as  pre- 
disposing and  various  accidents  as  exciting  causes. 


Sex. 

Causes. 

Age  Period 

Male. 

Female. 

Predisposing. 

Exciting. 

of 
Appearance 

Hereditary. 

Accidental. 

in  Hemi- 
decades. 

Mixed 
Neu- 
roses. 

Epi- 
lepsy. 

Alco- 
holism. 

Syphi- 
lis. 

Trau- 
matism. 

Injury  to 
Mother 
During 

Gestation. 

Denti- 
tion. 

Acute 
Sick- 
ness. 

5 

5-10 

10-15 

15-20 

Not  stated 

99 
26 

7 

3 

21 

68 
9 
3 
1 

13 

71 

8 

4 

2 

20 

II 

4 

2 

IO 
2 

3 

2 
I 

34 
9 
4 
2 
I 

13 

3 
5 

IO 

16 

9 
2 

2 

Total 

156 

94 

105 

17 

15 

3 

5o 

21 

IO 

29 

250 

140 

no 

The  study  as  will  be  seen  does  not  go  beyond  the  twentieth  year, 
which  is  the  generally  accepted  age  limit  beyond  which  epilepsy 
rarely  develops.  There  are  of  course  instances  to  the  contrary, 
especially  if  there  be  a  history  of  direct  inheritance  where  a  consti- 
tution, either  through  prepotency  of  other  heredity  or  by  means  of 
well-regulated  habits  of  living  had  thus  far  been  enabled  to  resist, 
has  after  this  period  succumbed  to  sudden  shock,  physical  or  mental ; 
so  also  indulgence  in  any  of  the  vices,  or  even  a  change  from  a 
regular  to  an  irregular  habit  of  life  may  break  down  all  the  safe- 
guards so  carefully  built  up,  and  bind  the  victim  captive  to  his  in- 
herited ill.  Again,  as  has  been  previously  shown,  the  epilepsy  of 
adult  life  may  prove  not  developmental,  but  recurrent  and  traceable 
to  infantile  convulsions. 

In  the  diagnosing  of  individual  cases,  the  symptoms  manifested 
in  the  seizures  claim  the  first  attention.  These,  as  presented  in 
four  well-defined  classes,  have  given  the  symptomatic  classification 
which  is  both  convenient  and  practical.  Taking  them  in  order  from 
the  more  generally  diffused  to  the  localized  forms,  we  have  grand- 
mal,  petit-mal,  psychical  epilepsy  and  Jacksonian  or  focal  epilepsy. 


EPILEPSY.  2  I  5 

The  first,  grand-mal,  is  literally  what  its  name  denotes  and  can- 
not fail  of  recognition.  There  may  or  may  not  be  the  warning  cry, 
the  patient  simply  drops  with  the  whole  body  convulsed,  teeth 
set,  often  upon  the  tongue,  and  the  mouth  foaming.  The  face 
flushes  and  pales  to  the  point  of  lividness,  and  relaxed  conditions 
often  cause  involuntary  evacuations  of  both  bladder  and  rectum. 
Loss  of  consciousness  is  the  ordinary  rule,  to  which  of  course  there 
may  be  exceptions.  Thus,  I  remember  exclaiming  over  a  beau- 
tiful boy  in  a  convulsion  of  unusual  severity,  "  How  sad !  Were  he 
my  child,  I  would  rather  he  were  dead."  The  next  day  he  asked, 
"  What  would  you  do  if  I  were  your  child  ?  You  turned  away  and  I 
didn't  hear."  The  seizure  is  generally  followed  by  some  mental  con- 
fusion and  by  sleep  prolonged  and  heavy.  Convulsions  may  however 
follow  in  such  rapid  succession,  as  to  permit  only  partial  return  of 
consciousness  causing  the  condition  known  as  status  epilepticus,  the 
attacks  not  infrequently  lasting  for  days.  I  recall  one  case  where 
for  three  days  the  spasms  were  repeated  every  two  and  a  half  min- 
utes with  clock-like  regularity.  Rupture  of  a  blood  vessel  or 
death  from  exhaustion  may  intervene  within  a  few  hours,  or  uncon- 
sciousness may  deepen  into  coma.  There  is  elevation  of  temperature, 
a  quickening  of  pulse  and  respiration,  and  not  infrequently  partial  or 
complete  hemiplegia;  with  returning  consciousness  there  is  often 
found  impairment  of  memory. 

Petit-mal  differs  from  grand-mal  in  degree,  not  in  kind.  Usu- 
ally, the  attacks  being  less  severe,  the  patient  does  not  fall. 
There  is  simply  a  paling  or  flushing  of  the  face  accompanied  by  a 
gasp,  a  sigh,  or  a  momentary  loss  of  consciousness.  The  attack 
may  not  be  sufficient  to  interrupt  either  work  or  conversation — the 
speaker  merely  pausing  for  a  moment  only  to  resume.  Again  there 
may  be  giddiness  or  a  fainting  spell.  These,  however,  are  apt  to  in- 
crease in  force  and  frequency  and  eventually  merge  into'  the  more 
violent  form  of  grand-mal. 

Psychic  epilepsy,  first  recognized  and  named  by  Weiss  is  less 
frequently  encountered  than  other  forms.  In  this,  as  the  name  im- 
plies, the  convulsion  is  mental  rather  than  physical,  and  might  by 
the  uninitiated  be  easily  mistaken  for  insanity.  The  seizure  coming 
without  premonition,  increases  in  force  for  hours  and  even  days ; 


2l6  EPILEPSY. 

then  gradually  subsiding  is  followed  not  by  coma,  but  by  a  period 
of  automatism.  In  a  state  of  absent-mindedness  the  patient  may 
pursue  his  regular  duties  automatically,  from  habit,  like  a  machine, 
rather  than  with  an  intelligent  knowledge  of  what  he  is  doing. 
Weiss  reports  the  case  of  a  man  whose  attacks,  lasting  through  sev- 
eral days,  were  characterized  by  frantic  swayings  to  and  fro  and 
shouts  of  fire ;  another  of  a  boy  whose  one  desire  at  these  times  was 
to  kill  something.  His  malady  gradually  assumed  the  form  of 
grand  mal. 

Jacksonian  epilepsy  differs  markedly  from  the  other  varieties.  In 
this  the  attack  begins  in  some  peripheral  portion  of  the  body — in 
the  leg,  in  one  side  of  the  face,  or  most  frequently  in  the  muscles  of 
the  hand  or  thumb.  The  convulsive  movements  are  circumscribed, 
and  are  confined  to  one  portion  of  the  body.  Consciousness  is  rarely 
entirely  lost,  sometimes  not  even  disturbed,  the  patient  being  aware 
of  what  goes  on  around  him.  There  is  a  singular  proclivity  among 
some  epileptics,  as  among  hysterical  people  and  criminals,  to  simulate 
spasms,  always  of  course  with  an  ulterior  motive,  such  as  the  Eng- 
lish "  dummy  chuckers  "  who  feign  convulsions  on  the  street  while 
their  confederates  pick  the  pockets  of  the  crowd.  Detection  of 
feigned  epilepsy  however,  is  quite  simple.  The  actor  invariably  falls 
without  injury,  nor  does  he  ever  bite  his  tongue;  however  violent 
the  movements,  they  are  always  coordinated,  and  moreover  as  his 
curiosity  gets  the  better  of  him,  he  cannot  resist  the  temptation  to 
open  an  eye  occasionally  to  see  the  effect  of  his  stratagem ;  then 
of  course,  the  greater  the  sympathy  elicited,  the  greater  the  vio- 
lence of  the  spasm.  The  remedy  is  generally  a  counter  movement, 
thus :  A  bucket  of  cold  water  coming  unexpectedly  quieted  one 
case  of  hystero-epilepsy ;  for  another,  preparations  for  the  cutting 
of  a  girl's  magnificent  growth  of  hair  quickly  changed  her  writhing 
to  recognizable  screams  of  anger;  a  large  dose  of  fluid  extract  of 
ipecac  and  warm  water  promptly  restored  a  third.  It  is  needless  to 
say  however,  that  such  remedies  are  to  be  personally  administered 
and  not  given  by  prescription.  The  symptoms  of  grand  mal,  as 
already  given,  are  unmistakable,  and  the  differential  diagnosis  be- 
tween the  epileptic  and  the  hysterical  spasm  is  clearly  set  forth  in 
the  following  table,  taken  from  Gowers. 


PLATE    XXXVIII. 


Case  C. 
CRETINOID. 


EPILEPSY. 


217 


Epileptic. 

Hysteroid. 

none. 

any,  but  especially  unilateral 
or  epigastric  aurse. 

always  sudden. 

at  onset. 

rigidity,  followed  by  "jerk- 
ing," rarely  rigidity 
alone. 

tongue. 

frequent. 

occasional. 

never. 

a  few  minutes. 

to  prevent  accident, 
spontaneous. 

emotion. 

palpitation,  malaise,  choking,  bilat- 
eral foot  aura, 
often  gradual. 

Onset 

during  course. 

Convulsion  

rigidity    or    "struggling,"    throwing 

Biting  

about  of  limbs  or  head,  arching 

of  back, 
lips,    hands,    or   other    persons   and 

things, 
never. 

Micturi  tion 

never. 

Talking 

frequent. 

more  than  ten  minutes,  often  much 

Duration 

Restraint  necessary... 
Termination  

longer, 
to  control  violence, 
spontaneous  or  induced  (water,  &c. ). 

The  premonitory  symptoms  most  common  among  my  cases  ob- 
servable in  both  sexes  were,  the  epileptic  cry  in  about  60  per  cent. ; 
rapid  debilitation  up  to  the  moment  of  seizure  after  which  the  re- 
cuperation was  equally  rapid  in  about  7  per  cent. ;  maniacal  violence 
in  periods  varying  from  a  few  hours  to  several  days  in  about  10  per 
cent. ;  running  and  climbing  preceding  an  attack  in  some  5  per  cent, 
of  males,  and  3  per  cent,  of  females.  There  were  also  several  inter- 
esting individual  examples :  One  boy  rotated  rapidly  on  one  foot, 
another  on  both  feet  before  falling ;  and  a  boy  professing  to  have  no 
fear  of  thunder  and  lightning,  had  invariably  a  seizure  at  the  ap- 
proach of  a  storm,  the  spasms  continuing  throughout  its  duration. 
An  attack  may  occur  without  premonition,  or  it  may  be  preceded 
by  an  aura.  Gowers  says  that  aurae  are  observable  in  fully  50  per 
cent,  of  all  seizures,  but  in  my  observations  I  find  less  than  20  per 
cent.,  and  they  of  the  following  character.     (See  Table,  page  218.) 

Pathology,  thus  far,  has  furnished  little  more  than  grounds  for 
conjecture.  If,  according  to  generally  accepted  theory,  spasms  are 
but  an  excessive  accumulation  and  sudden  discharge  of  nervous 
energy,  due  to  imperfection  and  impairment  of  the  sensory  and  motor 
cells,  then  naturally  we  look  to  pathologic  conditions  of  the  brain 
for  a  solution  of  the  question,  and  for  facts  concerning  theory. 

But  so  far,  we  may  as  well  question  the  silenced  gun  of  its  cannon- 
ading !  The  explosion  has  come  and  gone,  and  left  no  trace  of  how. 
Indeed  macroscopically  the  nerve  centers  generally  present  a  normal 


218 


EPILEPSY. 


Aurae. 

Male. 

Female. 

Total 

Pain  in  prsecordia,  and  stinging  sensation  traveling  from 

left  hand  upward,  and  down  left  leg. 

I 

Stinging  sensation  in  right  foot. 

I 

Stinging  sensation  in  right  arm. 

I 

Stinging  sensation  in  left  arm. 

I 

Numbness  in  left  arm  and  fingers. 

I 

Tingling  in  both  hands. 

I 

2 

Tickling  in  palm  of  left  hand 

2 

2 

Numbness  in  feet. 

2 

2 

Peculiar  coldness  in  breast. 

I 

I 

Pain  in  abdominal  region  traveling  upward. 

4 

4 

Extreme  nervousness. 

I 

I 

Dizziness. 

7 

4 

II 

Sensation  of  burning  in  face. 

3 

3 

Nausea  and  vomiting. 

i 

2 

3 

Sensation  of  suffocation. 

i 

i 

Rigors. 

2 

2 

Sleepiness. 

I 

I 

Tinnitus  aurium. 

I 

I 

2 

26 

14 

40 

appearance,  although  there  may  in  some  cases  be  slight  opacity  of  the 
membranes  and  possible  evidences  of  meningitis.  Even  microscop- 
ically the  changes  noted  are  slight  and  are  apparently  of  secondary 
origin ;  as  Gowers  tells  us  "  the  changes  in  the  nerve-elements  are 
probably  of  that  molecular  character,  which  is  revealed  only  by 
altered  function  and  eludes  the  most  minute  research."  True,  in  cases 
of  status  epilepticus  the  necropsy  will  reveal  intense  congestion — the 
veins  and  sinuses  deeply  engorged,  the  meninges  injected,  and  the 
white  portion  of  the  brain  show  punctate  hemorrhages,  whereas  the 
gray  matter  is  darkened  or  of  a  pink  tinge;  but  these  might  also 
be  found  in  cases  of  prolonged  asphyxia  which  were  non-epileptic, 
and  therefore  can  be  accepted  only  as  result  and  not  cause  of  seizure. 
The  prognosis  in  epilepsy  is  most  grave.  Death,  always  immi- 
nent, may  come  at  any  moment,  any  spasm  being  liable  to  terminate 
in  asphyxia  or  in  brain  suffusion.  Fully  25  per  cent,  of  all  deaths 
occur  in  status  epilepticus,  or  else  the  enfeebled  constitution,  unable 
to  resist,  succumbs  readily  to  the  inroads  of  disease,  especially  to 
tuberculosis,  or  to  cardio-vascular  affections,  to  which  all  epileptics 
are  peculiarly  susceptible.  Mental  impairment  also  may  always  be 
counted  upon — gradual  but  certain  in  its  progress.  Idiocy,  imbecility 
or  dementia  will  be  found  in  fully  90  per  cent,  of  all  epileptic  com- 
munities.    In  apparent  controversion  of  this,  Napoleon,  Rousseau, 


EPILEPSY.  219 

Mohammed,  Julius  Caesar  and  even  St.  Paul  himself  have  been  cited 
as  epileptics.  But  is  not  every  genius  abnormal — one  side  of  the 
nature  developed  at  the  expense  of  the  other,  and  such  asymmetry 
but  an  exposition  of  the  law  of  compensation?  Not  only  do  these 
stand  thus  acknowledged  by  history,  but  even  were  it  conceded  that 
they  were  perfectly  developed  men  they  would  still  be  accounted 
singular  exceptions  to  the  numbers  of  epileptics  recognized  in  all 
ages  as  incapables.  Again  there  has  been  much  talk  of  cure ;  but 
when  we  think  of  one  in  every  500  as  epileptic  and  then  follow  the 
very  scant  statistics  of  those  who  have  claimed  to  cure,  we  are  not 
encouraged  to  believe  that  a  specific  has  yet  been  discovered. 

Trousseau  states  that  out  of  150  cases  of  epilepsy  treated  by  him, 
he  had  20  recoveries.  Beau  and  Maisonneuve  estimate  their  re- 
coveries at  4  per  cent.  Bielefeld  claims  to  discharge  6.5  per  cent, 
recovered.  The  Craig  Colony  for  Epileptics  considers  that  from  7 
to  10  per  cent,  might  be  cured,  and  from  60  to  70  per  cent, 
improved.  This  latter  statement  my  experience  fully  confirms, 
but  I  have  no  faith  in  permanent  recoveries,  nor  do  I  think  there 
is  yet  data  from  prolonged  investigation  sufficient  to  substantiate 
such  assertion.  But  release  from  such  affliction,  even  for  a  time, 
cannot  but  be  accounted  a  boon,  and  the  fact  that  treatment  and 
environment  can  accomplish  this  is  surely  a  sign  of  progress  and 
a  victory  for  science.  There  are,  as  before  stated,  many  examples  of 
complete  immunity  for  varying  periods  of  time.  I  have  now  under 
my  care  a  man  aged  36,  with  a  record  of  convulsions  at  two  and 
one-half  years,  who  within  the  past  four  years  developed  epilepsy. 
For  two  years  the  attacks  increased  in  force  and  frequency  but 
yielding  gradually  to  treatment,  for  the  past  twelve  months  there  has 
been  complete  cessation  of  spasms ;  nevertheless  a  recurrence  at  any 
time  would  not  be  unexpected. 

A  reduction  from  several  seizures  a  day  to  the  same  number  a  year 
is  not  infrequent  with  my  patients.  With  one  there  was  a  change 
from  28  in  one  day  to  I  every  10  days.  This  marked  periodicity  in 
return  is,  however,  an  exception.  Epileptic  seizures  as  a  rule  recur 
at  irregular  intervals  induced  by  any  adverse  change;  indigestion, 
undue  depression  or  excitement,  or  even  sudden  changes  of  weather, 
having  noticeable  effect  in  increasing  the  number  of  spasms.     The 


220  EPILEPSY. 

life  period  in  epilepsy  is  mercifully  brief.  There  seems  a  consensus 
that  in  a  general  way  every  spasm  encroaches  more  and  more  upon 
the  physical  and  mental  tenure ;  twenty-five  years  being  the  average 
age  limit,  the  comparatively  few  who  enter  upon  or  who  pass  the 
thirties,  age  rapidly,  become  in  fact  physiologically  old  and  begin  to 
show  the  faltering  step  and  withered  skin  of  seventy.  Exceptions 
there  are,  where  the  periods  of  immunity  from  attack  have  been  more 
or  less  prolonged,  or  where,  as  in  Jacksonian  epilepsy,  the  nervous 
discharge  is  circumscribed,  confined  it  may  be  to  the  motor  area  of 
the  brain,  without  encroaching  upon  or  affecting  contiguous  areas. 
A  remarkable  case  of  longevity  is  cited  in  the  British  Medical 
Journal : 

The  man  was  a  confirmed  epileptic  for  fifty-seven  years,  during 
which  time  it  is  estimated  that  he  must  have  had  more  than  60,000 
fits,  without  any  apparent  impairment  of  his  faculties.  By  trade  a 
basket-maker,  he  would  be  interrupted  by  attacks  varying  in  num- 
ber from  five  to  thirty  a  day,  but  returning  to  his  work  apparently 
so  little  inconvenienced,  that  both  he  and  his  wife  accustomed  to  their 
occurrence,  came  to  regard  them  as  part  of  their  daily  life.  He  died 
during  an  epileptic  seizure,  however,  at  the  age  of  seventy-one. 

In  this  case  it  may  have  been  possible  that  the  distraction  and 
diversion  of  a  congenial  occupation,  by  preventing  that  moodiness 
and  introspection  so  common  a  cause  of  complications  in  epilepsy, 
may  have  contributed  to  circumscribe  as  well  as  to  lessen  the  force 
of  spasms;  for  the  mental  faculties  aroused  and  quickened  in  one 
direction  are  more  able  to  resist  attack  in  another,  consequently 
mental  enfeeblement  is  slower  in  progress  and  encroachment  upon 
other  areas  imperceptible,  if  not  temporarily  arrested.  There  can  be 
no  doubt  but  that  the  influences  of  moral  and  social  environment  have 
a  large  place  in  the  treatment  and  modification  of  epilepsy,  more  es- 
pecially when  medical  treatment  has  so  far  gained  control  as  to  secure 
temporary  cessation  of  spasms.  Through  periods  gradually  extended 
it  is  possible  to  study  with  greater  accuracy,  and  to  adapt  treatment 
to  individual  needs,  so  that  as  the  time  approaches  for  a  seizure,  by 
the  precautionary  measures  of  rest,  diet,  the  avoidance  of  exciting 
causes,  and  the  use  of  special  remedies,  frequently  an  attack  may  be 
averted.     Such  possibility  and  to  this  end,  the  urgent  necessity  for 


Plate  XXXIX. 


-'■« 

. 

<pP 

\  M 

'■A^    Em 

/ 

-•'1     * 

'  W 

Us  4^ ' :  1 

&&?$ 

^v^ffiV^^^^^^^^u^"^^v^^^^E3J8l^^.'^^''; 

1   i 

^^ 

|g& 

EPILEPSY.  221 

constant  exercise  of  will-power  by  the  patient,  cannot  be  too  strongly 
insisted  upon.  Just  as  he  finds  in  the  effort  to  simulate,  and  under 
conditions  that  favor  it  that  he  may  bring  on  a  spasm,  just  so  may 
he  be  brought  to  recognize,  that  with  some  assistance  outside  of  him- 
self he  may  avert  or  defer  an  attack,  and  therefore  that  it  is,  in  a 
measure,  under  his  own  control. 

I  frequently,  at  theatrical  entertainments,  exact  promises  from  epi- 
leptics that  there  shall  be  no  spasms  during  the  performance,  and  the 
evening  always  passes  without  such  interruption,  the  attention  being 
diverted  and  held,  while  the  will  is  unconsciously  exerted  and  cen- 
tered upon  one  aim  with  definite  result.  A  striking  example  of  the 
value  of  pre-occupation  and  concentration  of  thought  and  will  upon 
congenial  occupation  as  an  aid  in  treatment,  is  found  in  a  patient 
now  some  twenty-two  years  of  age,  a  hydrocephalic  epileptic,  one 
of  three  children  all  imbeciles  of  middle  grade,  with  family  his- 
tory of  intemperance  on  both  sides.  Responding  first  to  treat- 
ment— hygienic  and  medical,  including  frequent  baths  and  care- 
fully arranged  dietary — he  was  enabled  to  enter  school  and  follow 
a  course  of  manual  training  in  various  lines.  Observation  being 
encouraged  and  interest  aroused  by  household  occupations  and 
by  the  care  of  plants  and  animals ;  life  and  nature  studies  were 
daily  reproduced  in  paper,  in  chalk  and  clay  modelling,  in  free-hand 
drawing  and  color  combinations,  in  cardboard  and  wood  con- 
structive work,  and  in  applied  design.  The  muscular  development 
and  coordination,  absolutely  necessary  to  skill  and  dexterity  in  the 
use  of  tools,  was  acquired  in  daily  physical  and  gymnastic  exercises, 
while  the  powers  of  attention  and  quick  response  were  further  stimu- 
lated by  military  drill.  During  a  period  of  twelve  years  of  entire 
immunity  from  seizures,  he  has  grown  to  be  quite  a  useful  member 
of  his  community,  although  his  mental  limit  has  been  reached; 
whereas,  out  in  the  world,  he  would  have  been  a  pauper,  a  tramp, 
or  a  criminal  possibly  serving  now  his  term  in  the  penitentiary. 
A  fairly  good  artisan,  he  has  accomplished  very  creditable  cabi- 
net work  in  both  the  making  and  carving  of  furniture,  and  is  in 
frequent  demand  for  odd  jobs  in  both  painting  and  carpentry.  Of 
good  bearing,  strong  and  muscular,  excelling  in  athletic  sports,  the 
only  explosions  he  is  subject  to  at  present  are  sudden  bursts  of 


222  EPILEPSY. 

temper,  quite  as  soon  over.  I  have  never  considered  him  other  than 
an  epileptic,  and  a  reappearance  of  seizures  may  be  looked  for  at  any 
time  when,  with  other  brain  complications,  degeneration  will  be 
rapid  and  life  soon  over.  But  treatment  and  training  have  combined 
to  give  him  12  years  of  comparatively  useful,  happy  existence,  and  to 
show  how  the  work'  makes  the  workman  even  more  surely  than 
does  the  workman  the  work.  This  may  be  considered  a  typical  ex- 
ample of  what  treatment  and  training  together  with  suitable  environ- 
ment can  accomplish  for  certain  forms  of  epilepsy.  That  no  one 
method  can  be  given  as  a  specific,  is  shown  in  the  case  of  a  school- 
mate of  his,  about  the  same  age  and  to  all  appearances  similarly 
affected.  For  this  boy  of  a  higher  grade  of  mentality,  possessed  of 
great  physical  beauty  and  an  attractive  personality,  the  same  treat- 
ment seemed  to  open  even  greater  possibilities,  the  malady  being  so 
far  under  control  as  even  to  admit  of  his  travelling  alone  on  one 
occasion,  as  far  as  from  Boston  to  Philadelphia.  But  the  period  of 
exemption  in  his  case  was  never  extended  beyond  a  few  months,  and 
with  a  recurrence  of  spasms  came  rapid  and  complete  deterioration, 
and  to-day  in  the  utterly  helpless  epileptic  idiot  there  is  not  a  trace 
of  the  once  beautiful  boy. 

As  the  treatment  must  be  individual,  a  healthful,  cheerful  environ- 
ment is  of  the  first  importance  in  experimenting,  selecting  and  adapt- 
ing means  to  an  end.  A  life  in  the  open  with  occupations  and 
diversions  that  will  encourage  and  tempt  to  exercise,  and  con- 
veniences for  and  inducements  to  frequent  bathing — the  hot  bath 
gradually  reduced  in  temperature  is  best — the  system  thus  aroused 
and  alert  must  not  be  stultified  by  over-eating,  to  which  most  epi- 
leptics are  given,  nor  unhealthfully  stimulated  by  indulgence  in  petty 
vices.  A  simple  dietary  and  regular  rest  periods  must  form  the  basis 
of  a  renewal  of  a  life  whose  only  wholesome  variation  is  to  be 
found  in  congenial  occupations  so  arranged  and  varied  as  to  offer 
constant  stimulus,  aided  by  daily  physical  exercises  gradually  ex- 
tended and  prolonged,  but  never  to  the  point  of  fatigue.  With  seiz- 
ures in  a  measure  controlled  and  the  system  thus  toned  up,  any  excess 
of  exhilaration  may  be  corrected  by  sedatives  and  such  other  means 
as  individual  needs  suggest.  To  the  epileptic,  always  susceptible  to 
influence  or  even  suggestion,  any  change,  be  it  that  of  medical  attend- 


EPILEPSY.  2  23 

ant,  nurse,  location,  diet  or  medication,  may  cause  amelioration  suffi- 
cient to  build  upon.  Thus  must  the  treatment — moral,  mental,  phys- 
ical, dietetic,  and  medical — constantly  interchange  and  assist.  During 
a  spasm  it  is  only  necessary  to  place  a  pillow  under  the  patient's 
head,  loosen  the  waist-band  and  collar,  and  allow  the  paroxysm  to 
pass.  The  old  custom  of  attempting  to  restrain  the  limbs  dur- 
ing the  convulsion  is  most  reprehensible.  The  remedies  upon  which  I 
mainly  rely,  are  the  bromides — preferably  bromide  of  sodium — com- 
bined with  arsenic  as  a  guard  against  acne,  omitting  one  week  in 
every  eight,  so  as  to  allow  the  system  to  recuperate.  In  some  cases 
the  best  results  may  be  obtained  by  giving  the  bromide  with  the  food, 
excluding  all  salt,  and  sprinkling  it  in  its  place.  This  is  said  to  act 
two  or  three  times  more  powerfully  than  the  drug  administered  in 
other  ways. 

The  fluid  extract  of  solanum  carolinense  has  been  highly  recom- 
mended, and  one  writer  claims  wonderful  results  in  eight  cases.  I 
placed  twelve  boys  and  twelve  girls  on  it,  and  the  increase  in  both 
force  and  frequency  of  spasms  was  alarming.  Hydrastin  in  full 
doses  was  tried,  on  twelve  cases,  with  the  same  result.  I  placed  one 
hundred  cases  on  the  fluid  extract  of  eupatorium  perfoliatum  in 
doses  of  from  one-half  to  one  drachm,  according  to  age,  in  combina- 
tion with  from  ten  to  fifteen  grains  of  bromide  sodium.  This  acted 
well  for  a  time,  but  on  withdrawing  the  bromide,  the  last  state  was 
far  worse  than  the  first.  Tincture  of  adonis  vernalis  in  combina- 
tion with  bromide  of  potash,  has  acted  well  in  twelve  cases ;  bromipin 
in  twelve  also  has  reduced  the  force  and  frequency  of  spasms,  but  I 
have  failed  to  get  results  hoped  for  in  the  use  of  tincture  of  simulo. 
In  anemic  cases,  I  find  a  combination  of  arsenic,  tincture  of  chloride 
of  iron,  and  bromide  efficacious.  Nitrate  of  silver  in  one  case 
proved  effective,  and  codein  in  others,  and  not  infrequently  with 
girls,  bromide  and  belladonna.  I  have  never  met  with  much  suc- 
cess in  the  use  of  nitro-glycerine,  of  cannabis  indica,  of  zinc  or  of 
borax. 

Fleschig  uses  opium  in  large  doses  three  times  a  day  for  six 
weeks,  then  omitting,  gives  the  bromides  in  equally  large  doses  for 
two  months.  I  have  tried  this,  but  neither  with  it  nor  with  the 
hyoscyamin,  have  I  obtained  good  results.     In  several  cases  where 


224  EPILEPSY. 

there  was  an  aura,  I  have  prevented  a  spasm  by  applying  a  ligature 
and  in  others  by  the  inhalation  of  nitrite  of  amyl. 

In  status  epilepticus,  I  first  try  chloroform,  and  if  this  does  not 
act  promptly,  I  give  a  hypodermatic  injection  of  morphia  and  atropia, 
repeated,  if  necessary.  A  hypodermatic  injection  of  pilocarpin  may 
be  used,  but  the  depressing  effects  of  this  drug  are  so  pronounced 
that  great  care  must  be  exercised  to  avoid  fatal  results. 

In  nocturnal  epilepsy,  I  have  obtained  good  results  from  the  com- 
bination of  a  single  bromide  with  a  small  dose  of  chloral. 

Epileptics  are  generally  of  a  constipated  habit.  The  bowels 
should  be  kept  open  by  an  occasional  enema  or  by  a  gentle  laxative. 
Cascara  singly  or  in  combination  is  most  excellent,  or  at  times 
calomel  in  minute  doses.  Epsom  salts  or  Hunyadi  Janos  water  may 
be  administered  regularly  in  obstinate  cases. 

Surgical  treatment  is  much  vaunted  but  in  my  experience,  of  nine 
cases  only,  the  results  are  not  encouraging.  One  of  these,  a  bright 
lad  of  fifteen,  an  apt  Greek  and  Latin  scholar  studying  for  the 
priesthood,  had  been  troubled  with  petit  mal  and  later  had  an  attack 
of  grand  mal  lasting  several  days.  He  was  trephined  and  reduced 
to  the  condition  of  a  profound  idiot,  incapable  even  of  self-help. 
There  was  cessation  of  spasms  for  eight  years,  but  they  returned  and 
he  finally  died  during  an  epileptic  seizure. 

The  diet,  which  should  be  light  and  largely  vegetarian,  may  in- 
clude all  simple  foods — milk,  eggs,  broth,  cereals,  fruits  well-ripened, 
avoiding  those  with  small  seeds.  Meat  may  be  given  sparingly — not 
oftener  than  once  a  day — and  any  article  that  appears  to  disagree 
with  the  patient  should  be  withdrawn.  As  most  epileptics  are  apt 
to  gormandize,  the  patient  should  not  be  allowed  to  overload  his 
stomach  nor  to  sleep  until  after  the  completion  of  gastric  digestion. 

The  consideration  of.  treatment  and  methods  of  dealing  with  epi- 
leptics leads  naturally  to  the  question  of  environment  and  conditions 
under  which  these  can  be  best  carried  out.  For  the  wealthy  or  the 
fortunate  is  opened  every  amelioration,  even  that  of  occupation  and 
the  many  social  diversions.  But  it  is  to  the  family  of  moderate 
means,  to  the  bread-winner,  or  to  the  very  poor,  that  the  burden  of 
such  a  member  proves  insupportable,  more  especially  when  to  the 
mother  this  added  care  brings  all  the  nameless  terrors  of  ills  threat- 


EPILEPSY.  22  5 

ening  children  coming  to  the  birth.  A  source  of  constant  anxiety 
to  others,  the  unfortunate  is  himself,  in  many  instances,  gradually 
forced  into  a  life  apart.  Cut  off  more  or  less  from  school  compan- 
ionship and  association,  opportunities  narrow  for  discovering  that 
occupation  for  which  he  is  best  fitted,  and,  consequently,  means  of 
training  also.  Indeed,  however  well  prepared  he  may  become,  his 
infirmity  must  always  prove  an  impediment  to  securing  positions  of 
trust  and  responsibility.  An  object  thus  of  terror  or  of  pity  and 
commiseration,  he  gravitates  toward  a  life  of  self-indulgence  or  of 
monotony  and  loneliness,  tending  greatly  to  produce  mental  deteri- 
oration, a  deterioration  furthered  by  the  temptation  to  deviate  from 
the  regular  routine  and  special  diet,  prescribed  though  it  may  be 
by  a  family  physician  in  whom  he  places  the  utmost  confidence. 
Not  only  this,  but  various  phases  of  the  disease  are  characterized  by 
wanderings,  delusions,  or  even  by  the  perpetration  of  violent  acts, 
of  the  performance  of  which  the  patient  may  be  oblivious  at  the  time, 
but  which  render  him  none  the  less  dangerous  because  irresponsible. 
I  recall  an  instance  of  a  young  man  who  was  most  violent,  during 
seizures  which  were  unfailingly  characterized  by  a  desire  to  kill  his 
mother ;  another,  ordinarily  quiet  and  inoffensive,  having  delusions 
of  persecution,  would  alarm  the  neighborhood  by  running  out  at 
night,  half-nude,  and  holding  conversations,  as  he  supposed,  with  the 
Deity.  Finally,  in  great  bites,  he  began  literally  to  eat  himself  up 
at  "  the  command  of  God."  A  third  case,  a  woman  who  twice  poi- 
soned herself  with  Paris-green  would  swallow  whole  boxes  of  but- 
tons, and  at  last  committed  suicide  by  leaping  from  a  window.  Yet 
another,  a  woman  of  means — gentle,  refined,  cultivated,  and  quite 
capable  of  the  management  of  her  own  business  affairs — I  saw  on  the 
street  kicking,  screaming,  and  struggling  with  a  policeman  sur- 
rounded by  a  jeering  crowd. 

Both  home  and  community  life  revolt  from  such  disturbance  of 
equilibrium,  and  an  effort  to  escape  from  these  conditions — condi- 
tions intensified  by  rapid  increase  and  as  yet  unrestrained  by  suit- 
able marriage  laws — has  led  to  the  crowding  of  these  unfortunates 
into  insane  asylums  or  into  institutions  for  the  feeble-minded.  This 
is  a  double  wrong — a  wrong  to  the  institutions  to  whom  their  care 
is  a  matter  quite  apart  from  their  legitimate  aims,  and  to  the  indi- 
15 


226  EPILEPSY. 

vidual,  a  palpable  injustice,  not  only  placing  him  in  a  false  position, 
but  condemning  him  to  an  association  which  does  not  conduce  to  his 
advancement.  Treatment  he  receives,  and  that  of  the  best,  but  in 
hospital  or  in  institution  wards  he  is  more  lonely  than  in  the  home, 
with  no  added  motive  for  active  pursuits,  and  no  incentive  to  arouse 
a  sluggish  will.  Valuable  it  may  be  to  science,  this  massing  of  the 
afflicted  in  asylum  wards,  thus  facilitating  the  collection  and  com- 
parison of  data,  but  it  cannot  be  denied  that  the  end  desired  for  the 
individual  has  not  thus  been  attained.  With  all  the  benefits  of 
skilled  treatment  and  multiplied  creature  comforts,  a  life  of  mere 
invalidism,  with  nothing  to  divert  the  sufferer's  attention  from  the 
shadow  of  coming  ill,  is  at  best  but  a  maimed  existence.  Without 
the  stimulus  of  congenial  employment  and  the  continued  awakening 
of  the  powers  within,  one  loses  the  sense  of  "  going  on  and  on  and 
ever  to  be,"  and  sinks  into  a  dull  apathy  which  can  hardly  be  termed 
living.  It  was  the  knowledge  of  this,  as  well  as  the  conviction  of 
the  certainty  of  ends  to  be  attained  even  by  a  child  putting  forth  his 
best  efforts  and  working  among  his  peers  in  fair  and  equal  competi- 
tion, that  has  been  at  once  the  inspiration  and  the  success  of  Biele- 
feld, and  of  the  Craig  Colony.  The  substitution  of  home  for  insti- 
tution life,  by  division  into  small  families,  according  to  condition, 
social  standing,  sex,  or  previous  occupation;  opportunities,  in  the 
form  of  schools  for  the  young  and  of  training  for  all  according  to 
individual  proclivity ;  and  the  many  avenues  opened  for  industrial 
pursuits  and  definite  aims  in  life ;  and  lastly,  the  scientific  investiga- 
tions, leading  always  to  greater  amelioration,  are  the  essential  prin- 
ciples that  govern  these  splendid  organizations,  which  may  well  be 
emulated  by  all  future  communities  of  defectives. 

Dietary  for  Epileptics. 
To  be  modified  to  suit  individual  cases. 
All  cereals. 

Rice  thoroughly  cooked. 
Broths  and  soups. 

Toast ;  bread  and  butter ;  crackers  ;  buns. 

Poultry  ;  roast  beef ;  steak ;  Hamburg  steak  ;  roast  mutton  ;  fresh 
fish;  oysters,  raw,  panned  or  stewed.    All  used  sparingly. 


ARTICLES  TO  BE  AVOIDED.  227 

Eggs — shirred,  dropped  or  boiled  for  twenty  minutes  until 
creamy. 

Potatoes — sweet  and  white — cooked  in  any  way  except  fried 
and  browned.     Tomatoes,  stewed — strained  to  avoid  seeds. 

Beans ;  peas ;  asparagus ;  onions ;  lettuce ;  spinach ;  beets. 

Apples — stewed  or  baked ;  oranges  ;  bananas ;  peaches  ;  cherries ; 
dried,  evaporated  or  canned  fruit. 

Ice-cream  and  water-ice;  gelatin;  jellies;  simple  puddings;  plain 
cake;  junket;  cheese. 

Cocoa  ;  milk ;  lemonade ;  weak  tea  and  coffee. 

Condiments  and  salt  should  be  used  sparingly,  if  at  all. 

Articles  to  be  Avoided. 

Cabbage ;  pork  ;  veal ;  fried  oysters  ;  lobster ;  crabs  ;  salmon.  Rich 
cakes,  puddings  or  pies.     Fruits  with  small  seeds. 

If  a  non-uric  acid  diet  be  necessary  exclude  absolutely  all  meats ; 
poultry;  eggs;  fish;  shell-fish;  coffee  and  tea;  salt  and  condiments. 


CHAPTER   XI. 
idiots  savants  and  insanity. 

Idiots  Savants. 

Idiots  savants — "  learned  idiots  " — are  mental  defectives  of  vari- 
ous grades,  who  have  special  talents  in  one  or  more  directions,  but 
who  may  otherwise  be  very  deficient,  both  mentally  and  physically. 

They  are  not  examples  of  but  exceptions  to  the  usual  imbecile 
class ;  those  in  whom  the  mental  processes  are  slow  or  in  some  direc- 
tions deficient,  but  who  possess  some  well-marked  talent  out  of  all 
proportion  to  their  mental  calibre,  which  they  exercise  with  wonder- 
ful facility,  often  automatically. 

Many  of  those  exhibited  in  cheap  museums,  or  the  side-shows  of 
the  circus  as  "  lightning  calculators,"  "  musical  phenomena,"  "  mir- 
ror writers,"  and  as  wonderful  checker,  card,  or  chess  players,  be- 
long to  this  class. 

The  psychology  of  the  condition  is  involved  in  uncertainty  and 
obscurity,  and  even  were  the  physiologic  processes  known,  it  would 
still  be  impossible  to  tell  the  why  and  the  wherefore  of  the  peculiar 
talent.  In  the  majority  of  cases  I  note  a  history  of  meningitis  dur- 
ing infancy. 

Peterson  says  that  idiots  savants  have  great  facility  in  imitation — 
are  mere  copyists,  with  no  power  of  spontaneous  invention.  While 
the  power  of  imitation  is  one  peculiar  phase,  I  do  not  always  find 
originality  lacking  and  can  cite  at  least  two  cases  to  the  contrary. 
The  first,  a  musician,  improvises  readily  on  both  organ  and  piano. 
The  other  who,  in  caricature  drawing  a  second  Nast,  not  only  illus- 
trates but,  drawing  free-hand  with  rapidity,  will  execute  any  sugges- 
tion, elaborating  and  originating  as  he  goes  along,  always  incorporat- 
ing some  peculiarity  of  the  individual. 

Peterson  further  finds  "  the  aptitudes  frequently  lost  before  adult 
life."  Our  experiences  differ  in  this  also,  as  both  the  cases  I  have 
cited  and  many  others,  had  passed  the  twenty-first  year  with  talents 
cultivated  and  gaining  through  exercise. 

228 


Plate  XL. 


MICROCEPHALUS. 


IDIOTS   SAVANTS.  229 

I  find,  however,  with  Down,  this  class  confined  to  males  and  have 
yet  to  see  a  female  idiot  savant,  and  the  only  one  I  know  of  on  record 
is  Quenan,  an  idiot  at  the  Salpetriere,  a  mute  making  her  wants 
known  by  grunts  and  cries,  understanding  simple  signs  but  not  con- 
versation, and  unable  to  dress  herself,  who,  notwithstanding,  was 
said  to  be  a  rare  musician. 

Langdon  Down  reports  an  interesting  group  of  cases.  One  boy 
could  model  ships  from  drawings  and  carve  with  great  skill,  yet 
could  not  read  a  sentence.  His  writing  was  mere  drawing;  thus 
on  one  occasion  he  copied  verbatim  a  letter,  to  send  to  his  mother, 
although  it  did  not  approach  in  word  or  sentiment  what  he  wanted 
to  express. 

Another  exhibited  marvelous  skill  with  crayons,  and  yet  the 
higher  faculties  of  the  mind  were  a  comparative  blank. 

He  cites  also  cases  of  tenacity  of  memory ;  a  boy,  having  once  read 
a  book,  could  recite  pages  verbatim  without  an  error.  Down  consid- 
ered this,  however,  simply  a  process  of  verbal  adhesion  or  automa- 
tism, for  reading  one  day  a  chapter  of  Gibbon,  he  skipped  a  line  on 
the  third  page,  and  upon  discovering  his  mistake,  he  retraced  his 
steps.  Ever  after,  when  reciting  from  this  book,  he  would  skip  a 
line  on  the  third  page,  go  back,  and  correct  the  error  with  as  much 
regularity  as  if  it  had  been  part  of  the  text.  Later  his  memory  for 
recent  reading  weakened,  but  the  recollection  of  this  never  failed 
him. 

Another  boy  could  tell  the  tune,  words,  and  number  of  almost 
every  hymn  that  he  had  read ;  and  yet  another,  the  name  and  address 
of  every  confectioner's  shop  he  had  ever  visited,  and  the  date  of 
each  visit. 

One  child  could  tell  the  date  of  arrival  of  all  the  children  at  the 
institution,  and  could  supply  accurate  and  reliable  information  of 
each  when  needed. 

One  boy,  about  twelve  years  old,  could  multiply  any  three  figures 
by  three  other  figures  with  perfect  accuracy,  as  rapidly  as  they  were 
written;  yet  he  was  of  such  low  mental  grade  that  although  he 
had  seen  and  talked  to  the  doctor  every  day  for  over  two  years,  he 
could  not  tell  his  name. 


23O  IDIOTS    SAVANTS   AND   INSANITY. 

A  case  of  improvisation  was  that  of  a  boy,  who  taking  a  book  and 
pretending  to  read — an  art  he  had  not  acquired — would  improvise 
stories  with  great  skill  and  in  variety  to  suit  the  tastes  of  his  hearers. 
Another  could  recollect  the  airs  he  heard  at  an  opera,  and  hum  and 
sing  them. 

Another  case  showed  the  unusual  faculty  of  perfect  appreciation 
of  time.  The  boy  seventeen  years  old  did  not  understand  the  dial, 
but  could  name  the  precise  minute  at  any  period  of  the  day  and  in 
any  situation.  Tested  on  many  occasions,  he  always  answered  with 
a  precision  that  was  truly  remarkable.  As  deterioration  progressed, 
response  became  less  ready  and  he  could  only  reply  when  a  little 
excited ;  shaken  up  like  an  old  watch,  the  time  would  again  be  cor- 
rectly given,  but  gradually  as  his  health  became  enfeebled,  the  fac- 
ulty departed.  The  necropsy,  beyond  two  well-marked  and  distinct 
commissures,  revealed  no  difference  between  his  cerebrum  and  that 
of  a  normal  brain.  Down's  explanation  of  the  phenomenon  is,  "  that 
as  every  movement  in  the  house  was  absolutely  punctual  he  had 
data  from  which  he  could  estimate  the  time  by  accurate  apprecia- 
tion of  its  flux." 

Maudsley  describes  the  case  of  an  imbecile  who,  after  once  reading 
a  newspaper,  could  shut  his  eyes  and  repeat  what  he  had  read  word 
for  word.  He  also  mentions  a  case  of  one  who  could  repeat  back- 
ward what  he  had  just  read. 

A  remarkable  case  was  pointed  out  to  me  at  the  Asylum  of  Earls- 
wood,  England.  A  man  of  middle  life,  an  imbecile  of  middle-grade, 
a  wonderful  engraver  who  could  copy  a  steel  engraving  with  such  ac- 
curacy and  precision  that  it  was  almost  impossible  to  distinguish 
them  apart.  His  large  work-shop  was  filled  with  beautiful  and 
curious  things,  all  the  work  of  his  own  hands.  Carvings  in  ivory, 
dainty  as  lace;  a  ship  of  state — an  original  conception,  representing 
the  British  Empire — with  angels  guarding  the  prow,  Neptune  with 
his  trident  at  the  helm,  oars  in  place  and  the  Union  Jack  over  all. 
An  automaton,  a  giant,  thirteen  feet  high,  covered  with  a  cloth,  he 
could  not  be  induced  to  exhibit  to  me.  An  indefatigable  worker,  he 
had  rigged  up  a  peculiar  movable  seat  in  the  window,  adjusted  to 
various  heights  that  he  might  gain  light  upon  his  work  at  any  hour. 
Dr.  Corner  told  of  his  writing  to  the  present  King,  then  Prince  of 


INSANITY.  23I 

Wales,  asking  for  ivory  for  his  work,  and  in  due  time  came  a  pack- 
age, quite  a  large  one,  from  the  prince. 

Dr.  Howe  tells  of  an  idiot  who,  with  but  little  power  of  language, 
was  capable  of  wonderful  computations.  Thus,  given  a  man's  age, 
he  could  calculate  the  exact  number  of  minutes  he  had  lived. 

"  Blind  Tom,"  a  wonderful  musical  idiot  savant,  was  able  to  catch 
and  reproduce  any  air  he  heard,  and  to  play  two  tunes  on  the  piano 
at  the  same  time.  Of  very  low  grade  he,  in  true  imbecile  fashion, 
would  get  up  and  applaud  his  own  work. 

Gottfried  Mind,  an  imbecile  cretin,  who  died  in  Berne,  1841,  was 
so  clever  a  painter  of  cats,  singly  or  in  groups,  that  he  was  called 
the  "  Katzen-Raphael." 

The  peculiar  gifts  of  the  idiot  savant  include  aptitude  for  music 
and  art,  powers  of  imitation  and  quickness  of  apprehension  in  games, 
rapidity  in  arithmetical  calculations,  and  what  is  probably  the  base 
of  all  these,  a  retentive  faculty  deepened  in  certain  lines,  pronounc- 
edly evidenced  in  the  matter  of  dates  and  events.  Indeed  a  phe- 
nomenal memory  pertains  to  both  the  degenerate  and  the  genius,  and 
would  seem  the  border  line  showing  the  approach  of  one  to  normal 
and  of  the  other  towards  abnormal  conditions;  that  one-sidedness 
or  asymmetrical  development  of  great  intellectual  power,  associated 
with  extraordinary  memory  for  words,  dates,  and  isolated  facts,  of 
which  Macaulay,  Scott,  Franklin,  and  Goethe  are  notable  examples. 

Insanity. 

Not  infrequently,  among  the  feeble-minded,  there  is  intercurrent 
insanity;  again  among  the  insane  there  are  cases  that  have  had 
their  origin  in  mental  defect ;  thus,  the  idiot  born  with  limited  brain 
capacity  and  the  dement  whose  brain  is  worn  out  are  very  near  akin. 
It  is  a  distinction  in  difference,  not  in  kind ;  nevertheless  in  reality 
there  is  a  wide  difference.  Insanity  is  disease  of  the  brain  and  may 
prove  curable;  whereas  imbecility  is  defect — a  lesion  of  the  brain — 
and  we  cannot  cure  or  supply  what  is  not  there. 

Insanity  may  occur  among  mental  defectives  as  early  "as  the  first 
year,  manifested  by  dullness — incipient  melancholia — or  nervous 
excitability  developing  into  acute  mania.  The  torpid  thumb-suck- 
ing baby,  thin,  ■  anaemic,  constipated,   whose  attention   can   seldom 


232  IDIOTS    SAVANTS   AND    INSANITY. 

be  attracted  and  never  held,  is  a  type  of  the  one ;  and  the  screaming, 
restless,  sleepless  infant  with  variable  temperature,  quick  pulse, 
flushed  face,  wild  eyes  and  furred  tongue,  kicking  and  beating  con- 
tinually with  hands  or  head,  of  the  other  class. 

In  early  childhood  or  youth,  symptoms  of  melancholia  are  evi- 
denced in  loss  of  appetite,  constipation,  insomnia,  aimless  wandering 
or  sitting  apart  in  silent,  dull,  listless  fashion.  Depression  is  fre- 
quently accompanied  with  delusions  of  persecution  and  occasionally 
suicidal  impulses.  The  excitable  form  is  characterized  by  directly 
opposite  impulses.  There  is  perpetual  movement — chattering,  laugh- 
ing, screaming,  fighting,  biting,  attacking  others  regardless  of  con- 
sequences to  themselves,  sometimes  developing  homicidal  mania. 
Destructive  propensities  appear  in  the  insensate  desire  to  mutilate 
and  destroy  clothing,  furniture,  everything  within  reach.  Pyro- 
mania  is  not  an  infrequent  phase.  Delighting  in  filth,  they  will 
smear  their  bodies,  clothing  and  surroundings  with  garbage  and 
excrement  which,  with  appetite  voracious  and  perverted,  they  will 
even  eat. 

Overpressure  is  a  fruitful  cause  of  insanity;  to  force  a  child 
beyond  his  mental  limit  will  precipitate  an  outbreak  into  insanity  or 
a  lapse  into  idiocy.  Insanity,  therefore,  is  more  common  in  the 
higher  grades  of  imbecility,  although  I  have  had  cases  among  idiots. 

There  is  no  difficulty  in  establishing  the  diagnosis  of  insanity,  and 
the  prognosis,  is  generally  favorable  where  there  is  no  hereditary 
predisposition ;  although,  with  recurrence,  there  is  apt  to  be  increase 
in  both  force  and  frequency  of  attacks. 

The  treatment  requires  primarily  a  regular  life  free  from  undue 
excitement  or  fatigue ;  simple  food,  sleep,  exercise  and  periods  of  rest, 
occupation  and  recreation  alternating.  The  system  should  then 
be  built  up  with  tonics;  iron  and  arsenic  (Fowler's  solution)  alone 
or  in  combination  are  good.  Any  tendency  to  constipation  should- 
be  controlled,  using  cascara,  calomel,  or  Epsom  salts  as  occasion  or 
individual  needs  may  demand.  Trional  or  tetronal  are  excellent 
hypnotics,  especially  in  cases  of  destructive  proclivity. 


Plate  XLI. 


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CHAPTER   XII. 


ECHOLALIA. 


Within  the  last  decade  contributions  to  literature  relating  to  the 
various  forms  of  cerebral  speech  disturbance  have  been  more  or  less 
voluminous ;  but  they  have  been  devoted  almost  exclusively  to  those 
most  frequently  met  with,  and  the  rarer  one  of  echolalia  has  been 
'by  the  alienist  touched  but  lightly — an  analysis  of  the  term,  a  defini- 
tion, a  passing  word  of  comment — and  then  dropped.  It  remains, 
therefore,  that  the  literature  of  this  subject  is  most  meager,  the 
search  for  information  most  discouraging. 

Echolalia,2  or  echophrasia,  a  broader  and  more  comprehensive 
term,  although  not  yet  sanctioned  by  common  usage,  is  a  speech 
affection  characterized  by  a  tendency  to  repeat  words  or  phrases 
spoken  by  others,  hitherto  most  generally  observed  and  described  in 
combination  with  coprolalia3  or  with  palmus.4 

The  term  echolalia  was  first  employed  by  Romberg,  who  con- 
sidered it  an  evidence  of  cerebral  softening,  but  Echeverria5  notes 
it  as  a  sign  of  will-perversion  or  of  impaired  or  defective  inhibition. 

Giles  de  la  Tourette,  in  1885,  next  took  it  up  and  described  it  in 
connection  with  coprolalia  and  palmus. 

Noir,  in  1893,  made  a  careful  study  of  the  mental  degenerates 
(idiots  and  imbeciles)  of  France,  and  asserted  that  the  affection  may 
occur  singly  as  well  as  in  combination.  Landon  Carter  Gray6  coin- 
cides in  this  opinion,  and  my  own  experience  would  seem  to  verify 
the  same. 

1  Read  before  the  Philadelphia  Neurological  Society,  May  31,  1897.  Re- 
printed from  the  Journal  of  Nervous  and  Mental  Disease,  January,  1898. 

2 Exo,  Echo;  lalia,  Speech. 

3 Kopros,  Filth;  the  tendency  to  repeat  foul  language. 

*  Palmus,  A  twitch  known  also  as  latah,  myriachit,  tic  convulsif,  and 
jumper's  disease;  a  nervous  affection  characterized  by  localized  spasmodic 
movements. 

5  Dictionary  of  Psychological  Medicine,  vol.  I,  p.  424. 

6  The  American  Journal  of  the  Medical  Sciences,  May,  1895. 

233 


234 


ECHOLALIA. 


Tuke1  gives  echolalia  as  a  symptom  of  the  general  paralysis  of  the 
insane,  and  adds  that  it  may  be  associated  with  many  other  nervous 
disorders,  most  frequently  with  epilepsy — the  patient  in  some  cases 
imitating  in  his  speech  not  only  the  words,  but  even  the  tones  of 
the  person  addressing  him. 

Diligent  inquiry  among  alienists,  both  here  and  abroad,  and  a 
careful  study  of  imbeciles  and  of  speech  defect,  covering  together 
over  eight  thousand  cases,  give  the  following  data,  which,  although 
throwing  but  little  added  light  upon  the  subject  to-day,  may  yet  by 
its  grouping,  aid  in  future  scientific  investigations. 

Fletcher  Beach,  late  of  Darenth  Asylum,  says  that  echolalia  was 
very  uncommon  there,  although  a  few  cases  did  exist.  Shuttleworth 
also  found  it  in  a  few  cases  at  the  Royal  Albert  Asylum,  but  neither 
of  these  observers  gives  statistics. 

Reginald  Langdon  Down  finds  it  in  4  per  cent,  of  the  imbeciles 
under  his  care. 

Cesare  Lombroso,  in  a  personal  letter,  says  that  he  has  observed 
echolalia  in  hysterical  imbeciles,  but  never  in  microcephalic  idiots  or 
cretins,  whereas  W.  W.  Ireland's  opinion  in  this  direction  narrows 
the  field  even  more,  as  he  states,  in  a  recent  letter,  that  in  his  ex- 
perience echolalia  is  not  found  among  the  feeble-minded. 

A  case  reported  by  Lichtheim,  and  by  him  defined  as  transcortical 
motor  aphasia,  may  best  be  explained  by  the  following  diagram.2 


/ 


M 


./ 


B 

/\ 

/  \ 


\ 


\ 


\ 


\ 


Of  the  triangle  ABM,  let  B  represent  the  so-called  concept  center 

1  A  Dictionary  of  Psychological  Medicine,  p.  526. 

2  .With  thanks  to  Dr.  Spiller. 


ECHOLALIA.  235 

(Be griff scentrum  of  the  Germans),  M  the  center  of  motor  images, 
and  A  the  center  of  auditory  images.  "  The  reflex  arc  consists  in  an 
afferent  branch,  A-a,  which  transmits  the  acoustic  impressions  to 
A ;  and  an  efferent  branch,  M-m,  which  conducts  the  impulses  from 
M  to  the  organs  of  speech,  and  is  completed  by  the  commissure  bind- 
ing together  A  and  M."1 

"  A  variety  of  motor  aphasia  is  created  by  interruption  of  the 
path  B-M,  of  which  we  have  many  examples.  From  the  diagram 
we  should  expect  the  loss  of 

"(a)  volitional  speech, 

"(b)  volitional  writing,  whilst  there  are  preserved 

"(c)  understanding  of  spoken  language, 

"(d)  understanding  of  written  language, 

"(e)  the  faculty  of  copying. 

"  So  far  the  symptoms  coincide  with  those  of  Broca's  aphasia. 
They  differ  inasmuch  as  there  is  preservation  of 

"(/)  faculty  of  repeating  words, 

"(g)  writing  from  dictation, 

"(h)  reading  aloud."2 

Charlton  Bastian,  referring  to  this,  says :  "  Lichtheim's  interpreta- 
tion of  this  case  is  wholly  different  from  mine.  He  accounts  for  it 
by  supposing  a  damage  of  commissural  fibers  to  exist,  which  pass 
between  his  postulated  center  for  concepts  and  Broca's  convolution, 
which  for  him  also  is  a  motor  region  rather  than  one  of  sensory 
type."  He  goes  on  to  explain :  "  The  meaning  of  this  ability  to  read 
aloud  in  such  a  case  is  that  though  the  auditory  word-center  is  so 
much  damaged  as  to  be  unable  to  act  spontaneously  (that  is,  under 
volitional  stimuli),  it  is  still  capable  of  responding  to  the  associational 
stimuli  coming  to  it  as  a  result  of  strong  excitation  of  the  visual 
center.  Persons  so  affected  are  also  quite  capable  of  responding 
to  sensory  stimuli  passing  direct  to  the  auditory  center  itself — that  is, 
they  can  at  once  repeat  words  uttered  before  them."-3 

"  In  this  relation  it  may  be  mentioned  that  it  sometimes  happens 
that  the  speech  of  patients  is  entirely  limited  to  a  mere  imitative  repe- 

1  Lichtheim,  Brain,  vol.  VII. 

2  Lichtheim,  C.  c. 

3  Lancet,  April  10,  1897,  p.  1016. 


236  ECHOLALIA. 

tition  of  words  spoken  in  their  hearing,  while  they  are  without  the 
power  of  volunteering  any  statement;  that  is,  their  auditory  word- 
centers  respond  only  to  direct  sensory  incitations,  and  not  at  all  to 
those  of  an  associational  or  volitional  order.  In  these  cases  (usually 
included  under  the  term  'echolalia')  a  marked  general  impairment 
almost  invariably  co-exists." 

"  A  defect  of  this  kind  (occurring  in  a  woman  who  was  hemiplegic 
from  cerebral  hemorrhage)  has  been  recorded  by  Professor  Behier! 
She  was  born  in  Italy,  and  had  resided  both  in  Spain  and  France. 
Of  the  three  languages  she  had  thus  acquired  she  had  completely 
forgotten  the  Italian  and  Spanish,  and  had  only  retained  a  most 
limited  use  of  the  French.  In  this  latter  language  she  only  repeated 
like  an  echo  the  words  pronounced  in  her  presence,  without,  however, 
attaching  any  meaning  to  them.  But  in  the  case  of  a  woman  seen 
at  the  Salpetriere  by  Bateman,  the  mimetic  tendency  was  much 
stronger.  She  even  reproduced  foreign  words  with  which  she  had 
never  been  familiar.  It  is  clear  that  in  such  a  case  as  this  there  must 
have  been  a  mental  degradation  of  a  much  wider  kind  than  that 
which  occurs  when  the  auditory  word-center  alone  is  reduced  to  its 
lowest  grade  of  functional  activity."1 

Transcortical  motor  aphasia,  according  to  Dejerine,  is  entirely 
hypothetic,  being  in  his  opinion  only  a  stage  of  amelioration  in  the 
cortical  motor  aphasia  of  Broca. 

Mills2  thinks  echolalia  might  as  properly  be  classed  under  morbid 
impulses  as  under  aphasia,  and  describes  it  as  "  an  affection  in 
which  convulsive  movements  are  associated  with  sudden  explosion 
of  speech.  The  patient  with  a  grimace,  contortion,  or  violent  move- 
ment of  some  kind  suddenly  bursts  into  an  obscene,  profane,  or 
absurd  expression.  This  expression  may  be  the  echo  of  something 
overheard — hence  the  name,  echolalia — or  it  may  be  a  spontaneous 
outcry.  It  is  not  simply  an  hysterical  affection,  controllable  and 
curable,  but  it  is  a  true  monomania,  the  affection  of  speech  being 
beyond  the  patient's  volition."     In  a  still  later  article  he  classes  true 

1  Loc.  cit. 

2  American    Text-book    of    Diseases    of    Children ;    "  Speech    Defects    and 
Anomalies,"  p.  663. 


Plate  XLII. 


ECHOLALIA.  237 

echolalia  as  a  characteristic  symptom  of  transcortical  or  suprapic- 
torial  sensory  aphasia.1 

He2  cites  two  cases  of  echolalia  occurring  in  his  own  practice 
— one,  a  woman  of  cultivation  and  refinement,  who  would  burst 
out  with  a  thrice-repeated  oath  accompanied  by  an  abrupt  action; 
the  other,  a  boy,  who  would  give  unprovoked  utterance  to  filthy  lan- 
guage, accompanied  by  violent  movements  of  the  head,  shoulders, 
and  arms. 

Here  is  undoubted  association  with  both  coprolalia  and  palmus, 
as  in  an  analogous  case  coming  under  my  own  observation;  a 
beautiful  and  refined  young  girl  attending  a  "  mixed "  boarding- 
school,  would  at  intervals  give  sudden  expression  to  three  words 
successively — the  first  vulgar,  the  second  foolish,  the  third  profane — 
these  also  associated  with  convulsive  movements. 

In  a  personal  examination  of  2,500  mentally  defective  children,  I 
can  find  but  two  cases  of  what  might  be  called  true  echolalia.  One 
is  not  available,  but  the  other,  which  is  unique,  is  here  presented. 

Kirtie  M. ,  idio-imbecile,  white,  male,  epileptic,  aged  twenty- 
two  years,  with  the  intelligence  of  a  child  of  five.  He  is  the  eldest 
of  three  children,  the  brother  and  sister  being  strong  and  healthy, 
both  mentally  and  physically.  Family  history  good,  with  no  trace 
of  nervous  or  mental  disease.  The  parents,  people  of  exceptional 
refinement  and  intelligence,  are  distantly  related,  the  maternal  grand- 
mother and  paternal  grandmother  being  cousins  german.  Paternal 
grandfather  died  of  some  kidney  trouble  (form  unknown)  aged 
forty;  maternal  grandmother  of  some  heart  disease  (form  also  un- 
known) aged  sixty-seven.  Father  thirty-two  and  mother  twenty 
at  time  of  this  child's  birth.  Born  at  full  term,  ordinary  labor, 
nursed  by  mother;  had  no  peculiarities  beyond  an  unusually  large 
head,  and  a  perfectly  healthy  infant  up  to  sixteen  months  showing, 
the  father  says,  no  indication  of  mental  disease;  during  teething  he 
had  petit  mal,  gradually  followed  by  prolonged  spasms,  and  at  the 
age  of  four  developed  true  epilepsy,  any  excitement  precipitating  an 
attack.     He  began  to  talk  with  the  ease  of  a  normal  child,  but  early 

1  A  Text-Book  on  Nervous  Diseases,  Dercum,  p.  440. 

2  "  Aphasia,"  reprint  from  the  Review  of  Insanity  and  Nervous  Disease  for 
September  and  December,  1891,  p.  75. 


238  ECHOLALIA. 

developed  a  habit  of  peculiar  repetition ;  learned  the  alphabet  and  to 
repeat  with  facility  Mother  Goose  rhymes,  which  he  craved  to  have 
sung  to  him  daily.  His  precocious  memory  just  at  this  period, 
coupled  with  these  abnormal  repetitions,  first  attracted  the  attention 
of  those  about  him  as  evidencing  something  wrong. 

In  disposition  he  was  gentle,  easily  governed,  social,  liking  the 
presence  of  other  children  although  not  joining  in  their  plays,  would 
spend  hours  apart  amusing  himself  with  blocks  or  by  weaving 
strings. 

He  had  the  usual  diseases  of  childhood;  a  severe  attack  of  diph- 
theria was  followed  by  vasomotor  paralysis  of  the  left  side  of  the 
face,  which  gradually  yielded  to  treatment. 

Upon  first  entering  school,  he  cried  a  great  deal  and  talked  con- 
stantly about  "  a  nice  packer  o'  pins  and  a  buggy  and  wagon."  Sight 
and  hearing  good,  speech  limited,  and  enunciation  slightly  defective ; 
nervous,  restless,  and  self-willed,  working  himself  into  a  fury  when 
thwarted ;  muttering  incoherently  to  himself,  he  spent  a  great  deal  of 
time  twirling  and  untwirling  a  string  until  at  last  his  nervous  fingers 
found  employment  in  knitting ;  in  this  he  accomplished  quite  difficult 
patterns  without  assistance,  himself  setting  up  the  required  number 
of  stitches  and  adding  as  directed. 

He  can  now  count  to  fifty ;  is  fond  of  music ;  is  unable  to  read  and 
write,  but  household  service  has  proved  a  means  of  development 
for  him,  as  he  has  learned  to  wash  dishes,  sweep  and  dust,  and  is 
orderly  and  methodical  to  a  degree  quite  remarkable  for  one  of  his 
intellectual  grade;  thus  he  will  voluntarily  gather  up  all  the  litter 
from  the  floor,  winding  the  strings  into  a  ball,  and  on  leaving  the 
school-room  never  forgets  to  say :  "  Kirtie  come  to  school  this  after- 
noon !"  "  Kirtie  come  to  school  to-morrow !"  "  Kirtie  come  to  school 
Monday  morning!"  as  the  period  may  be,  without  once  misplacing 
time  or  event.  This  he  does  day  after  day,  invariably  speaking  of 
himself  in  the  third  person. 

From  this  it  will  be  seen  that  he  has  a  certain  degree  of  intelli- 
gence, although  he  still  passes  much  time  in  a  corner  smiling  and 
muttering  vacant  repetitions ;  repeating  whatever  he  hears,  his 
thoughts  are  those  of  others  and  his  speech  is  automatic.  When 
addressed,  he  rarely  fails  in  repetition  before  reply.     Thus  one  may 


ECHOLALIA.  239 

ask :  "  How  old  are  you,  Kirtie  ?"  and  he  will  immediately  repeat, 
taking  words  and  tones,  "  How  old  are  you,  Kirtie  ?"  But  here  may 
be  noted  a  departure  from  the  habit  of  precision  before  mentioned. 
He  is  now  twenty-two  years  of  age,  and  yet  to  the  question,  "  How 
old  are  you,  Kirtie  ?"  following  the  invariable  repetition,  "  How  old 
are  you,  Kirtie  ?"  comes  the  answer,  "  Twelve."  Though  accepting 
the  suggestion  that  he  is  now  twenty-two,  he  will,  after  a  few 
moments,  give  the  same  reply,  "  Twelve."  This  is  the  only  indi- 
cation he  gives  of  any  loss  of  memory,  and,  indeed,  I  think  it  may 
show  rather  the  presence  of  some  strong  overlaying  association  with 
that  number.  His  keen  sense  of  association  is  shown  further  in  the 
following  instance :  A  companion  of  whom  he  was  very  fond  died, 
and  some  four  years  later,  after  attending  a  service  of  song,  on  being 
questioned  as  to  where  he  had  been  he  replied,  "  Heaven,  heaven — 
home,  Joe  Zun — die  song — heaven,"  the  hymn,  "  Heaven  is  my 
Home,"  evidently  recalling  his  loss. 

His  memory  is,  indeed,  phenomenal.  He  recalls  not  only  the 
visits  of  his  parents  and  other  incidents  occurring  during  the  year, 
but  also  the  names  of  boys  and  attendants  he  has  neither  seen  nor 
heard  of  for  years,  and  he  will  sit  talking  to  himself  of  them.  He 
catches  readily  both  the  words  and  music  of  all  the  popular  songs  at 
first  hearing,  repeating  the  words  almost  verbatim,  or,  if  substi- 
tuting, giving  equivalents. 

One  of  the  most  interesting  experiments  with  him  appears  all  the 
more  wonderful  when  we  consider  his  low  mentality.  As  before 
stated,  he  not  only  repeats  words,  but  also  imitates  the  voice  and 
tone  of  the  speaker  and  frequently  follows  accurately  in  pantomime 
every  movement.  One  afternoon  I  gave  him,  in  rapid  succession, 
words  and  sentences  in  nine  different  languages :  English,  French, 
German,  Spanish,  Italian,  Japanese,  Latin,  Greek  and  Norwegian, 
and  each  time,  I  found  that  although  the  words  were  unfamiliar  and 
would  have  been  difficult  for  an  ordinary  person,  certainly  for  a  nor- 
mal child,  Kirtie  took  the  pronounciation  with  facility,  his  voice 
keeping  pace  with  mine  as  I  repeated : 

"  I  am  here  with  thee  and  thy  goats,  as  the  most  capricious  poet, 
honest  Ovid,  was  among  the  Goths." 

"  Liberty !  Freedom  !  Tyranny  is  dead  !  Run  hence,  proclaim  it 
— cry  about  the  streets,  liberty,  freedom,  and  enfranchisement !" 


240  ECHOLALIA. 

"  Pas  a  pas  on  va  bien  loin." 

"  Wir  seufzen  im  nachtlichen  Winde.  Vom  Zweige  ein  Wink 
so  fern." 

"  Superabundantissimente." 

"  Vedi !  le  fosche  notturne  spoglie,  de'cieli  sveste  l'immensa  volta." 

"  Namu  mio  ho  ren  ge  Rio." 

"  Potentissimus  est  qui  se  habet  in  potestate." 

"  Zoe  mou  sas  agapo." 

"  Min  norske  vinter  er  s  vakker,  med  hoida  snebedakte  bakker 
og  gronne  gran  med  pudret  haar." 

On  another  occasion  he  followed  me  in  the  same  words  through 
three  different  tones  and  inflections  of  voice — the  first  a  mere 
whisper,  the  last  amounting  to  a  shout,  his  voice  always  keeping 
tally  with  mine.  "  How  do  you  do,  Kirtie  ?"  "  How  do  you  do, 
Kirtie?  Pretty  well."  I  repeated  the  question  in  the  same  voice, 
then  suddenly  changing,  I  asked  the  question  in  a  loud  voice: 
"  Are  you  well,  Kertie  ?"  He,  expecting  the  other  question,  shouted 
back,  "  How  do  you  do,  Kirtie  ?  Pretty  well."  I,  realizing  that  his 
answer  was  automatic  and  that  there  was  no  reasoning  in  it, 
repeated  the  question  three  times  before  he  grasped  the  change, 
when  he  replied,  "  Are  you  well,  Kirtie  ?  Yes."  Placing  my  hat  on 
the  floor,  I  said,  "  Go  get  my  hat,  Kirtie."  This  the  boy  repeated 
three  times  without  attempting  to  move  from  his  seat,  seeming  not 
to  understand.  Finally,  picking  up  the  hat  and  tossing  it  from  me, 
I  repeated  the  request,  and,  as  if  aroused  by  the  action,  he  brought 
it,  still  repeating,  "  Go  get  my  hat,  Kirtie."  "  Thank  you,"  I  said, 
"  Thank  you,  thank  you,  thank  you ;  you  are  welcome,"  he  replied. 
"  What  did  you  take  out  of  Miss  Annie's  room  ?"  "  What 
did  you  take  out  of  Miss  Annie's  room?  Pins.  Must  not  steal 
pins  to  put  in  coat."  "  What  did  B.  B.  do  on  the  base-ball 
field?"  "  What  did  B.  B.  do  on  the  base-ball  field?  Ran  away  home. 
Bad  boy,"  and  so  on,  with  infinite  repetition. 

He  is  extravagantly  fond  of  blocks,  with  which  he  will  amuse 
himself  for  hours.  Some  years  ago  he  contracted  the  habit,  when 
irritated,  of  deliberately  tearing  his  clothing  to  pieces,  especially  his 
stockings.  The  deprivation  of  his  favorite  plaything  was  found  to 
be  the  best  discipline  for  this  offense.    Now,  when  his  nurse  attempts 


ECHOLALIA.  24 1 

to  put  away  his  blocks,  he  will  say,  "  Do  not  take  away  blocks ;  will 
not  tear  any  more."  If  asked  if  he  will  loan  or  give  a  block,  he  will 
reply  after  repeating  the  question,  "  No,  no,  I  will  not  tear  my 
clothes,"  and  when  asked  what  clothes,  replies,  "  My  stockings."  Oc- 
casionally, if  his  play  is  interrupted  by  a  spasm,  the  blocks  will  be 
scattered,  but  on  regaining  consciousness  he  immediately  gathers 
them  up,  knowing  exactly  both  their  position  and  their  number. 

Attention  is  here  called  to  the  fact  that  this  case  is  associated  with 
epilepsy,  but  neither  with  coprolalia  nor  with  palmus. 

Dr.  William  G.  Spiller,  who  has  been  an  interested  observer  of 
the  case,  and  to  whom  I  am  greatly  indebted  for  aid  in  the  work  of 
research  and  comparison,  says :  "  In  performing  a  necropsy  in  a  case 
such  as  you  present,  I  should  notice  especially  the  condition  of  the 
posterior  part  of  the  left  first  temporal  convolution.  The  fact  that 
the  boy  is  an  epileptic  is  a  point  in  favor  of  a  cortical  lesion,  though, 
of  course,  it  is  no  proof.  As  he  understands  all  simple  commands, 
and  obeys  them,  the  auditory  center  cannot,  therefore,  be  destroyed, 
but  it  may  be  so  damaged  that  it  is  incapable  of  responding  to  voli- 
tional stimuli,  yet  still  be  capable  of  responding  to  impulses  passing 
to  it  over  the  tract  aA.  I  am  not  able  to  accept  the  concept-center, 
and  would  prefer  to  explain  your  case  in  the  words  used  by  Bastian. 
To  me  your  patient  presents  a  symptom-complex  resembling  that 
of  transcortical  motor  aphasia." 

Summing  up  and  comparing,  we  find  echolalia  a  rare  form  of 
aphasia,  betokening  always  a  marked  general  mental  impairment, 
and  therefore  most  naturally  associated  with  other  forms  of  degen- 
eration. 

There  being  no  record  of  an  autopsy  of  such  a  case,  the  precise 
location  of  the  lesion,  if  there  be  one,  remains  yet  to  be  demonstrated. 

In  comparing  the  case  presented  with  Lichtheim's  proposition, 
we  are  confronted  at  once  by  a  difficulty :  the  boy  is  an  idio-imbecile, 
and  his  inability  to  read  or  write  closes  one  door  of  observation,  but 
we  do  find  in  common  with  his  table,  first,  "  loss  of  volitional  speech," 
and  second,  "  preservation  of  understanding  of  spoken  language  and 
of  faculty  of  repeating  words."  The  absence  of  volitional  speech, 
notwithstanding  an  abnormal  memory,  would  indicate  a  diseased 
•condition  of  the  motor  region,  but  not  destruction,  as  he  does  reply 
16 


242  ECHOLALIA. 

and  respond  to  the  word  of  command.  Even  the  repetition  of  words 
would  appear  almost  to  be  such  a  response,  or  an  exaggerated  form 
of  a  habit  of  obedience  to  suggestion,  for  it  is  automatic,  not  voli- 
tional or  reflective,  such  as  we  often  see  in  normal  persons — an  effort 
to  strengthen  the  sensory  impressions  so  as  to  apprehend  before 
acting. 

Thus  in  the  act  and  in  the  echo  he  is  simply  a  creature  of  sugges- 
tion. His  capacity  for  receiving  such  suggestion  so  rapidly  as  to 
echo  these  instantaneously  without  thought,  would  tend  to  show  less 
impairment  of  the  sensory  than  of  the  motor  centers,  and  therefore 
confirms  my  impression  that  the  defect,  not  so  much  sensory  as 
motor,  is  to  be  defined  rather  as  transcortical  motor  aphasia. 


CHAPTER   XIII. 

ADENOMA   SEBACEUM.1 

Among  the  diseases  peculiar  to  the  feeble-minded,  and  one  but 
rarely  seen  among'  normal  people,  none  is  more  curious  than  the 
cutaneous  affection  commonly  called  the  "  butterfly  disease  " — from  a 
fancied  resemblance  of  configuration — and  also  variously  known  as 
adenoma  sebaceum,  epithelioma  adenoides  cysticum,  ncevi  vasculaires 
et  papilla-ires,  vegetationes  vasculaires.  The  best  description  I  have 
met  with  is  that  of  Crocker,2  who  speaks  of  it  as  "  A  disease  com- 
posed of  neoplastic  papules  on  the  face,  of  congenital  origin,  but  of 
later  development." 

According  to  H.  G.  Brooke,3  adenoma  sebaceum  was  first  described 
by  Jacquet  and  Davies  in  1887,  under  the  title  of  Hydradenome 
eruptif.  Crocker  claims  that  Rayer  and  Addison,  and  Gull  reported 
the  first  cases,  but  that  it  was  not  positively  recognized  as  a  distinct 
affection  until  Balzar,  without  a  knowledge  of  the  earlier  cases, 
verified  the  description  by  a  similar  diagnosis.  We  read  that  there 
was  much  study  of  the  subject  without  any  definite  conclusions  being 
reached  as  to  its  pathologic  anatomy  and  relations,  its  source  and 
cause  of  origin,  the  earliest  and  latest  periods  at  which  it  appears, 
its  possible  modifications — macroscopic  and  microscopic — and  the 
limits  of  its  distribution. 

Vidal,  Hallopeau,  Pringle,  S.  Makenzie,  Caspary,  and  Crocker 
made  further  investigations,  but  I  cannot  find  records  of  more  than 
21  cases,  including  my  own,  that  have  been  studied  and  reported. 

Duhring  considers  the  disease  rare  and  requiring  investigation, 
Crocker,  however,  believes  it  not  so  rare,  but  that  as  the  subjects 
are  often  epileptic,  it  has,  therefore,  passed  unrecognized  by  neurolo- 
gists without  being  referred  to  dermatologists. 

1  From  the  Journal  of  Psycho-Asthenics,  March,  1899,  p.  137. 
2 "  Adenoma  Sebaceum,"  Diseases  of  the  skin,   1893. 

3 "  Epithelioma  Adenoides  Cysticum,"  British  Journal  of  Dermatology,  Sep- 
tember, 1892. 

243 


244  ADENOMA   SEBACEUM. 

Of  the  four  cases  of  adenoma  sebaceum  I  have  seen  among  the 
feeble-minded,  three  are  epileptics. 

Confined  to  the  face,  and  occasionally  found  on  the  forehead  and 
chin,  it  is  generally  of  central  location,  the  eruption  being  most 
abundant  on  the  sides  of  the  nose,  and  in  the  nasolabial  folds  where  in 
some  cases  it  becomes  confluent. 

The  distribution  of  the  lesions  is,  as  a  rule,  remarkably  symmetric, 
but  Crocker  reports  one  case  in  which  it  was  unilateral,  and  in  one 
of  my  own  cases,  the  eruption,  it  will  be  noticed  (fig.  2)  is  in  the 
right  frontal  region,  being  absent  on  the  left,  although  it  is  sym- 
metric on  other  parts  of  the  face. 

The  lesions  consist  of  roundish  papules  varying  in  size  from 
a  pin-point  to  that  of  a  split-pea.  The  majority  of  the  papules 
are  of  a  bright  crimson,  the  color  being  due  to  minute  telangiectatic 
vessels  that  invest  them.  Again,  they  may  be  but  slightly  colored 
or  translucent  and  waxy.  When  the  papules  are  very  numerous 
and  thickly  grouped,  they  usually  assume  a  cinnamon  or  brownish 
tint,  occasionally  paling  on  pressure.  A  few  scattered  lesions  may 
be  present  at  birth  or  appear  gradually  in  early  childhood,  or  they 
may  suddenly  increase  in  number  but  not  in  size,  at  puberty.  Once 
established,  the  disease  has  a  tendency  to  remain  stationary,  although 
the  papules  occasionally  undergo  involution,  leaving  significant  scars 
that  fade  in  time. 

All  cases  thus  far  reported,  with  the  exception  of  two  of  Crocker's, 
show  mental  deficiency;  mine  were  all  defectives  of  low  grade. 

Crocker  cites  a  case  occurring  in  an  exceedingly  clever  boy  of 
eleven,  and  another  in  a  woman  of  forty-eight,  whose  intelligence 
was  above  the  average. 

According  to  some  writers,  additional  defects  of  the  skin  are 
usually  found  to  be  present,  especially  fibromata  in  the  hair-follicles, 
pigmentation,  true  nevi,  and  warts.  I  have  met  with  none  of  these, 
except  the  last,  the  skin  in  all  cases  being  otherwise  free  from 
blemish. 

The  diagnosis  of  adenoma  sebaceum  is  not  generally  difficult, 
although  it  may  be  confounded  with  hidradenoma,  colloid  milium, 
and  acne  rosacea.  From  these  it  may  be  distinguished  by  the  fol- 
lowing differential  points : 


ADENOMA   SEBACEUM.  245 

In  hidradenoma,  which  is  also  of  congenital  origin,  the  lesions 
form  irregular  groups  on  the  trunk,  forehead,  and  face,  and  are  not 
telangiectatic.     Mental  deficiency  is  also  absent. 

Colloid  milium  is  found  most  frequently  in  middle-aged  or  elderly 
persons,  and  involves  chiefly  the  orbital,  temporal,  and  frontal 
regions.  The  lesions  are  few  in  number,  disseminated,  discrete,  of 
a  pale  lemon  color,  shining,  and  more  translucent  than  are  those  of 
adenoma  sebaceum. 

In  acne  rosacea  there  are  the  intense  hyperemia,  the  enlarged 
blood-vessels,  and  the  peculiar  acne  papules  and  pustules.  The 
affection  most  frequently  attacks  the  nose,  but  may  occasionally 
spread  over  the  entire  face. 

In  one  case  of  adenoma  sebaceum,  Balzar  found  the  lesions  only 
in  the  sebaceous  glands,  and  in  another  a  number  of  small  cysts  were 
present  in  both  the  sebaceous  and  the  sweat-glands. 

Pringle1  found  that  in  this  disease  the  corium  was  much  thickened, 
and  that  the  size  of  the  sebaceous  glands,  both  simple  and  compound, 
was  increased. 

Crocker,  who  examined  portions  of  skin  taken  from  the  cheek, 
forehead,  and  the  fibrous  lesions  of  the  back  of  one  of  his  patients, 
also  found  the  corium  thickened;  the  most  conspicuous  feature  he 
maintains,  however,  was  the  enormous  number  and  size  of  the 
sebaceous  glands,  the  upper  half  of  the  corium  being  studded  with 
rudimentary  hair-follicles ;  there  was  an  unusually  large  number  of 
sweat-coils  in  the  deeper  portion,  so  that  there  was  increased  develop- 
ment of  all  the  appendages  of  the  skin  situated  at  different  levels. 
The  papillary  vessels  were  conspicuous,  and  there  was  moderate  in- 
crease of  the  connective  tissue.  In  a  single  large  lesion  from  the 
forehead,  which  presented  so  different  an  appearance  when  viewed 
clinically,  the  most  marked  distinction  was  the  replacement  of  the 
enormous  number  of  hair-follicles  and  sebaceous  glands  by  fibrous 
tissue  with  fragments  of  hairs  and  glands  imbedded  in  it.  The 
lesions  of  the  back  were  centered  at  the  hair-follicles,  around  which 
dense  fibrous  tissue  had  developed  in  considerable  quantity,  the 
lesions  being,  in  short,  follicular  fibromata. 

1  J.  J.  Pringle,  "  A  Case  of  Congenital  Adenoma  Sebaceum,"  British  Journal 
of  Dermatology,  January,  1890. 


246  ADENOMA   SEBACEUM. 

Up  to  the  present  day  there  has  been  no  positive  response  to  treat- 
ment. The  French  have  experimented  with  electrolysis — the  galvano- 
cautery — but  the  records  of  these  experiments  are  still  too  incom- 
plete to  furnish  correct  data  or  to  give  proof  that  the  formation  of 
fresh  growths  has  been  checked  permanently. 

Hallopeau  removed  adenoma  lesions  from  a  patient  with  a  curet 
and  by  means  of  scarification,  but  they  returned  within  a  year. 
Pringle  tried  to  scoop  and  bore  out  nodules,  but  death  intervened 
before  the  effects  could  be  fully  determined.  Crocker  removed 
lesions  from  a  woman's  face  by  means  of  electrolysis;  in  a  few  ex- 
tensive cases  also,  he  excised  the  naso-labial  folds  on  each  side  of 
the  face  and  diseased  patches  on  the  forehead,  but  with  only  indif- 
ferent results. 

The  histories  of  my  cases  are  as  follows : 

Case  1. — C.  G.  Low-grade  imbecile  girl,  aged  nineteen ;  hair  dark 
brown ;  eyes  black ;  sight  and  hearing  good ;  voice  husky,  and 
enunciation  defective ;  very  talkative ;  noisy ;  indolent ;  obstinate,  and, 
cruel  to  other  children.  Mother  sixteen,  father  twenty-one,  at  time 
of  child's  birth.  Father's  family  said  to  be  scrofulous,  and  several 
of  its  members  to  have  had  a  "  breaking  out  of  the  skin  like  C.'s  " ; 
father  a  drunkard,  and  also  addicted  to  the  inordinate  use  of  tobacco. 
Maternal  grandmother  died  a  confirmed  dipsomaniac;  maternal 
grandfather,  of  "  some  heart  trouble " ;  paternal  grandfather,  of 
apoplexy.  C.  has  but  one  sister  living — the  mother  being  unwilling 
to  bring  other  children  into  the  world,  separated  from  her  hus- 
band. C.  began  to  walk  at  sixteen  months,  and  reached  mental 
limit  at  fourteen  years.  When  three  years  of  age  was  found  in  a 
spasm  due,  it  was  thought,  to  fright  at  the  screams  of  her  drunken 
father.  There  has  been  no  return  of  spasms,  but  she  is  extremely 
nervous. 

Given  a  fair  trial  in  school  she  was  able  to  learn  nothing  beyond  the 
simplest  manual  work — a  little  knitting  and  sewing. 

Plate  No.  1  shows  the  lesions  scattered  over  the  face,  but  con- 
fined chiefly  to  the  infra-orbital  space  on  each  side,  resembling 
in  outline  the  extended  wings  of  a  butterfly.  There  are  no  large 
sebaceous  cysts,  the  majority  of  the  lesions  being  of  a  bright  scarlet, 
shading  off  to  brown  or  Indian  red. 


Plate  XLIII. 


if    JKT   ml' 


SrtudYJiour.nH.shGfa^A. 


Cartoon   Drawn  by  Case  A. 
IDIOTS  SAVANTS. 


ADENOMA   SEBACEUM.  247 

Case  2. — J.  W.  Boy;  profound  apathetic  idiot;  mute;  nineteen 
years  of  age;  reached  mental  limit  at  fourteen;  light  brown  hair; 
hazel  eyes ;  sight  and  hearing  apparently  good ;  filthy  in  habits ;  unable 
to  wash  or  dress — indeed,  incapable  of  self-help  in  any  way  beyond 
feeding  himself  with  a  spoon.  Is  sluggish  in  habits.  Came  from 
almshouse,  and  but  little  is  known  of  family  history.  The  mother, 
lost  sight  of  for  years,  is  said  to  have  had  the  same  skin  disease  as 
the  boy.  The  lesions  are  scattered  thickly  over  the  face,  and  are  most 
prominent  over  the  left  forehead,  side  of  face,  and  chin.  There  are 
three  large  waxy  spots  between  the  eyes,  on  the  left  side  of  nose,  and 
in  the  left  infra-orbital  space.  Two  large  confluent  spots  appear  on 
the  upper  and  lower  rami  of  jaw. 

Case  3. — W.  S.  Boy ;  idio-imbecile,  thirteen  years  old ;  fifth  child ; 
born  at  full  term ;  difficult  labor,  but  non-instrumental  delivery ;  nour- 
ished by  mother,  and  was  apparently  a  strong  babe.  Convulsions  at  six 
months,  continued  frequently  up  to  the  time  he  was  two  years  of  age, 
since  which  time  there  has  been  no  return.  Father  a  machinist  and 
born  in  Ireland;  mother  born  in  England  is  subject  to  mild  attacks 
of  insanity ;  paternal  grandfather  died  at  forty  years  of  age  of  gastric 
fever;  paternal  grandmother  at  sixty-five,  of  bronchitis;  maternal 
grandmother  living,  was  confined  in  an  insane  hospital  for  a  time, 
and  had  a  feeble-minded  brother.  W.  has  three  brothers  living, 
apparently  sound  and  in  good  health ;  a  sister  died  when  six  days  old. 
W.  is  perfectly  formed  and  skin  is  clean,  with  the  exception  of  three 
warts  on  left  hand.  Light  hair ;  blue  eyes ;  sight,  hearing,  and  gait 
good;  slight  paralysis  on  right  side;  speech  imperfect,  and  vocabu- 
lary limited  to  a  few  words.  Extremely  nervous ;  unclean  in  habits. 
Excellent  memory;  powers  of  imitation  good,  and  has  a  wonderful 
talent  for  music ;  can  catch  any  tune  that  he  hears  but  once,  and  can 
distinguish  between  a  waltz,  a  two-step,  a  schottische,  and  a  ma- 
zurka ;  sits  and  hums  to  himself  all  day.  The  adenoma  sebaceum  is 
well  marked  on  face  and  has  been  present  since  birth.  The  lesions 
are  brownish  on  nose  and  over  eyes,  red  on  cheeks,  small  confluent 
telangiectatic  spot  on  left  temple,  two  confluent  spots  on  left  frontal 
region,  and  large  spot  on  right  chin. 

Case  4. — A.  F.  E.  Boy;  idio-imbecile;  aged  18  years.  Fam- 
ily history  incomplete.     Said  to  have  been  normal  until  the  age  of 


248  ADENOMA   SEBACEUM. 

two  years,  when  an  epileptic  seizure  occurred  lasting  six  hours  leav- 
ing the  left  side  permanently  paralyzed.  Had  spasms  at  regular  inter- 
vals until  the  age  of  seven,  when  struck  by  a  street-car ;  his  head  was 
seriously  wounded,  since  which  time  there  has  been  entire  cessation 
of  spasms.  Power  of  attention  slight ;  considerable  desire  to  imitate, 
but  without  much  success;  memory  extremely  poor.  No  trace  of 
moral  sense.  Rather  large  for  his  age;  general  health  excellent; 
speaks  a  few  sentences.  The  lesions  are  thickly  scattered  over 
cheeks  and  chin. 


CHAPTER   XIV. 

illustrative  cases. 

Idiots  and  Idio-Imbeciles. 

Idiots  :    Profound,  Apathetic — unimprovable. 

Case  A. — C.  E.  Boy;  six  years  old;  a  mute,  incapable  of  self- 
help.  Demands  the  same  care  as  an  infant.  Was  the  fifth  child, 
having  two  brothers  and  two  sisters  all  normal.  Born  at  full  term ; 
labor  ordinary.  The  parents  were  each  30  years  of  age  at  time 
of  this  child's  birth.  Two  years  prior  the  father,  a  machinist,  had 
received  a  severe  blow  on  the  head,  and  later  becoming  insane  died 
in  his  thirty-fourth  year  of  softening  of  the  brain. 

Case  B. — R.  C.  Boy;  six  years  old;  a  mute,  helpless  in  every 
way.  Born  at  full  term,  ordinary  labor.  Family  history  good,  but 
mother  had  a  severe  mental  shock  four  months  previous  to  child's 
birth,  and  he  himself  a  severe  attack  of  spinal  meningitis  at  18 
months.  Father  a  machinist  aged  32,  and  mother  21  at  time  of 
child's  birth. 

Case  C. — C.  B.  Male ;  twenty-one  years  old.  Semi-mute,  speak- 
ing only  a  few  short  words ;  is  helpless  and  unclean.  Born  at 
full  term,  ordinary  labor.  Had  spasms  at  birth.  Father  36  and 
mother  31  at  time  of  birth. 

Idiots:    Profound,  Excitable — unimprovable. 

Case  A. — D.  E.  R.  Boy;  twelve  years  old.  Red  hair  and  blue 
eyes.  A  mute  making  cooing  and  crooning  sounds  when  not  ex- 
cited and  noisy.  Unclean  day  and  night.  Incapable  of  self-help ; 
cannot  feed  himself  intelligently,  yet  carries  everything  he  lays  hold 
of  to  his  mouth,  seeming  to  have  a  peculiar  facility  in  swallowing 
stones  and  buttons.  At  one  time  passed  per  rectum  a  piece  of 
glass,  a  tack,  a  dress-hook,  a  button,  4  large  nails,  3  pieces  of 
nut  shells,  and  205  pebbles,  ranging  in  size  from  a  grape-seed  to 
a  shell-bark.  A  few  hours  later  he  swallowed  52  pebbles  and  a  but- 
ton, which  he  passed  the  following  morning.  At  another  time  he 
swallowed  168  buttons  and  a  tack.  At  still  another  time  he  swallowed 
and  passed  41  buttons,  1  nail,  an  iron  jack-stone,  a  ring  and  a  stone. 

249 


25O  ILLUSTRATIVE    CASES. 

Fifth  in  order  of  birth,  first  born  of  twins,  with  twin  sister  nor- 
mal, living.  Ordinary  labor,  nourished  by  mother.  When  6  years 
old  an  attack  of  scarlet  fever  left  him  deaf,  dumb,  blind,  and  para- 
lyzed. The  mother,  aged  39  at  time  of  child's  birth,  had  an  epileptic 
sister.  The  father  aged  44  when  child  was  born,  was  a  merchant 
of  wealth  and  position,  but  addicted  to  the  use  of  intoxicants  and 
drugs ;  died  from  the  effects  of  an  overdose  of  opium. 

Case  B. — W.  K.  Male ;  aged  26  years ;  $y2  feet  in  height,  and  well 
proportioned ;  has  a  peculiar  lurching  walk.  Eyes  and  hair  dark 
brown.  A  mute  but  very  noisy,  chiefly  from  3  to  5  o'clock  in  the 
morning.  Barking  like  a  dog,  or  roaring  like  an  animal,  he  could  eas- 
ily be  heard  a  quarter  of  a  mile  away.  Will  shout  and  growl  at  the 
sound  of  music.  When  excited  will  clasp  hands  and  face,  or  throw 
up  arms  as  if  to  strike.  Tears  food  and  eats  like  an  animal ;  is 
particularly  fond  of  rare  meat.  Can  use  spoon,  but  prefers  fingers. 
Developed  a  sort  of  affection  for  his  attendant  and  follows  him 
around  like  a  dog,  rubbing  against  him  and  showing  the  satisfaction 
of  an  animal  when  petted.  Knows  his  own  room  and  bed,  is  fond  of 
being  alone,  and  is  bestial  and  filthy  in  habits.  At  2  years  of  age  it 
was  noticed  that  he  was  somewhat  peculiar,  and  when  3  years  old 
he  fell  backward  into  a  tub  of  hot  water  and  was  severely  scalded. 
Two  brothers  and  2  sisters  living,  all  extremely  nervous  and  one 
choreic. 

Second  child;  labor  difficult,  but  without  instruments.  Nour- 
ished by  mother,  who,  always  delicate,  was  23  years  old  at  time  of 
child's  birth.  When  5  months  advanced  in  pregnancy  she  was 
severely  shocked  at  the  sight  of  an  idiot  child.  Father  a  farmer  and  a 
school  teacher,  aged  28,  was  wounded  in  Civil  War  and  carries  a  ball 
in  his  body;  suffers  continually  from  neuralgia.  Both  parents  have 
poor  digestion.  The  mother  has  an  idiot  cousin,  and  the  maternal 
grandmother  died  of  phthisis. 

Case  C. — M.  S.  Boy ;  eight  years  old.  A  demi-microcephal  and 
a  semi-mute ;  with  a  shuffling  gait  common  to  his  class.  Nervous 
and  excitable,  music  annoys  him,  causing  him  to  jump  and  scream 
and  to  cover  ears  with  hands  as  if  to  obstruct  sound.  Birth  pre- 
mature (8  months),  nourished  first  by  mother,  and  then  by  bottle. 
Second  child.  Has  two  brothers  and  one  sister,  all  living  and  healthy. 
Parents  were  the  same  age — 23  years — at  birth  of  child,  prior  to  which 
the  mother,  who  suffered  from  sick  headaches,  was  severely  fright- 
ened at  seeing  one  man  try  to  shoot  another.  The  father,  a  cigar- 
maker  by  trade,  is  extremely  nervous. 

Case  D. — M.  F.  Girl;  aged  13  years.  A  mute,  unable  to  care 
for  herself.  Excitable,  wild  and  noisy.  Wanders  restlessly  to  and 
fro,  screaming  and  shouting. 


Plate  XLIV. 


IDIOTS  SAVANTS. 


IDIOTS:    SUPERFICIAL,    APATHETIC — IMPROVABLE.  25  I 

The  first  born  child  died  at  6  months  of  pneumonia,  the  second 
was  still-born,  and  the  fourth,  an  epileptic,  died  of  cholera  infantum. 

The  paternal  grandfather  was  a  drunken  epileptic ;  the  father's 
brother  and  sister  are  feeble-minded  and  the  mother  has  an  epileptic 
sister. 

Born  at  full  term,  labor  easy,  was  the  third-born  of  triplets. 
Father  29,  and  the  mother  26  at  time  of  child's  birth;  owing  to 
husband's  drunken  habits,  the  mother  was  in  an  anxious,  worried 
condition  during  pregnancy. 

Idiots  :    Superficial,  Apathetic — improvable. 

Case  A. — P.  R.  Boy;  10  years  old.  Epileptic,  slightly  choreic; 
left-sided  spastic  hemiplegia.  A  mute;  fond  of  children  and  of 
music,  and  understands  simple  commands.  Has  improved  in  mat- 
ters of  self-help ;  learned  to  dress  and  feed  himself,  and  is  more 
cleanly  in  habits. 

He  was  the  sixth  child,  born  at  full  term;  ordinary  labor;  nour- 
ished by  mother.  Father  had  a  sister,  a  deaf-mute.  Family  history 
otherwise  unknown. 

Case  B. — B.  D.  Girl ;  12  years  old ;  semi-mute  of  quiet  habits,  but 
a  most  violent  temper  when  roused,  and  very  profane.  Was  very  un- 
clean, but  has  improved,  learning  to  wash,  feed  and  care  for  herself. 
The  first  birth  succeeding  3  miscarriages ;  labor  ordinary.  Nour- 
ished by  mother  who  claims  that  she  was  subjected  to  anxiety  and 
had  not  sufficient  food  during  pregnancy.  Father  a  laborer,  drank 
moderately,  but  not  to  excess.  B.  had  7  sisters  and  one  brother.  Of 
3  who  were  triplets,  1  died  at  birth,  1  in  five  weeks  and  1  in 
six;  the  brother  also  died  at  birth;  4  sisters  living  and  healthy. 

Case  C. — D.  J.  L.  Boy;  14  years  old.  Obstinate,  crying  habit- 
ually and  refusing  to  be  pacified.  A  semi-mute,  fond  of  mumbling 
to  himself,  while  twisting  and  playing  with  strings.  Became  more 
cleanly  in  personal  habits  and  able  to  aid  in  dressing  himself,  but 
would  eat  filth  and  garbage.  Died  of  phthisis,  the  necropsy  showed 
the  stomach  completely  filled  with  a  mass  conforming  to  its  con- 
figuration; this  mass  made  up  of  sticks,  stones,  paper,  bark,  strings, 
and  trash  of  every  description.  First  child,  born  at  full  term.  Labor 
difficult,  but  without  instruments.  Deficient  animation  at  birth ;  was 
always  a  sickly  baby;  nourished  by  mother.  Father  32  and  mother 
26  at  birth  of  child.  Mother  extremely  nervous  during  pregnancy. 
Maternal  grandparents  first  cousins. 

Case  D. — A.  D.  Boy;  16  years  old.  A  semi-mute,  repeating  only 
a  few  words,  but  able  to  make  his  wants  known.  Was  always 
delicate — a  case  of  spina  bifida.     Learned  to  feed  himself  and  be- 


25  2  ILLUSTRATIVE    CASES. 

came  cleanly  in  habits.  Tenth  child,  fifth  son.  Born  at  full  term; 
labor  not  difficult,  was  a  "  water  baby."  Nourished  by  mother,  who 
rambling  and  erratic,  was  destitute  of  the  moral  sense.  When  three 
months  pregnant,  while  nursing  her  husband  with  a  broken  leg,  she 
was  forced  to  lift  him  frequently.  Father  then  45  and  mother  37. 
Father  a  mason  by  trade,  drank  to  excess  and  died  two  years  later  of 
dropsy.  Of  10  children,  3  have  died  of  consumption,  1  of  abscess  of 
the  brain,  1  of  epilepsy,  and  2  of  the  diseases  of  childhood. 

Case  E. — C.  R.  Male;  23  years  old.  Listless,  and  appreciating 
little  that  was  said  to  him.  Improved  in  self-help  and  became  cleanly 
in  habits.  When  a  boy,  had  a  fall  from  a  porch.  Fifteenth  child, 
born  at  full  term,  ordinary  labor,  nourished  by  mother,  who,  34  years 
of  age  at  time  of  child's  birth,  had  afterwards  6  miscarriages. 

All  the  12  children  living  are  more  or  less  mentally  defective;  3 
children  died — 2  of  premature  birth,  and  1  of  pneumonia.  Father  a 
laborer,  was  36  at  time  of  child's  birth. 

Case  F. — J.  C.  W.  Boy ;  18  years  old.  Shuffling  gait,  drooling 
mouth.  After  5  years  of  persistent  care,  became  cleanly  in  habits  and 
could  make  his  wants  known;  learned  to  feed  and  partially  to  dress 
himself.     J.  is  the  fourth  born ;  labor  difficult,  with  instruments. 

During  the  fourth  month  of  pregnancy,  the  mother  was  pro- 
foundly shocked  by  seeing  her  mother  almost  torn  to  pieces. 

The  father,  a  moulder,  drank  occasionally. 

Idiots  :   Superficial,  Excitable — improvable. 

Case  A. — A.  P.  Boy;  7  years  old.  A  mute;  understands  what 
goes  on  about  him.  Sight  and  hearing  good.  Was  extremely  ner- 
vous and  in  perpetual  motion,  and  very  unclean.  Was  incapable  of 
self-help,  but  has  become  more  cleanly  in  habits  and  less  restless. 

Had  frequent  falls  in  infancy  and  when  2  years  old  was  run  over 
by  a  milk  wagon.  Sixth  born.  Difficult  labor  with  instruments ; 
nourished  by  mother;  4  sisters  living;  1  brother  dead-born.  Father 
had  an  epileptic  brother.  Father  35,  and  mother  33  at  time  of  A.'s 
birth. 

Case  B. — A.  B.  Boy;  7  years  old.  Semi-mute.  Restless,  ner- 
vous, filthy  in  habits,  needing  constant  care.  Sits  the  entire  day  re- 
peating to  himself  or  singing  fragments  of  nursery  rhymes,  which  he 
once  knew  perfectly.  Was  a  sort  of  infant  prodigy  in  a  musical  way. 
Became  less  restless  and  more  cleanly,  but  has  so  deteriorated  men- 
tally that  he  does  not  even  recognize  his  mother  after  a  few  days' 
separation.  Father  a  railroad  man,  was  31,  and  mother  29,  at  time 
of  child's  birth.  Mother  melancholy  during  pregnancy  with  this  her 
first  child.     Difficult  labor  with  instruments.     Spasms  3  days  after 


IDIOTS:    SUPERFICIAL,    EXCITABLE — IMPROVABLE.  253 

birth  and  was  always  a  feeble  infant.  Nourished  by  mother  for  two 
months.  Family  history  good,  except  that  maternal  aunt  was 
epileptic. 

Case  C. — J.  D.  Boy;  10  years  old.  Semi-mute,  understanding 
all  that  is  said  to  him.  Extremely  nervous,  passionate,  vulgar  and 
unclean.  Has  learned  to  feed  himself  and  become  more  cleanly,  but 
is  very  destructive — constantly  tearing  his  clothing.  J.  was  the  first 
child  born  at  full  term,  ordinary  labor,  nourished  by  mother.  Had 
spasms  when  a  baby.  One  brother  and  one  sister  living,  both  nor- 
mal. This  a  case  of  congenital  syphilis.  Paternal  grandfather  died 
of  cancer,  and  maternal  grandfather  of  apoplexy. 

Case  D. — F.  T.  Boy ;  5  years  old.  Epileptic.  A  mute,  but  could 
understand  and  respond  to  signs  and  motions.  Obstinate  and  sulky. 
Sent  to  training  class ;  made  very  slight  progress.  Gradually  learned 
to  feed  himself  and  to  become  more  cleanly  in  habits,  but  as  spasms 
increased,  became  destructive,  tearing  his  clothing,  etc.  Would  eat 
garbage  of  every  description.    Died  during  an  epileptic  seizure. 

Is  the  illegitimate  child  of  a  low-grade  imbecile  woman. 

Case  E. — A.  F.  Boy;  13  years  old.  An  epileptic  with  spasms 
at  long  intervals.  Recognizes  ordinary  things  about  him ;  speaks  a 
few  words  with  very  indistinct  enunciation.  Has  learned  to  feed, 
dress  and  undress  himself  with  some  assistance,  and  there  has  been 
gradual  improvement  in  habits  of  self-help  and  cleanliness.  At 
times  is  very  excitable.  A  mere  pigmy  of  a  child,  was  born  in  the 
almshouse.  Labor  difficult;  the  mother,  27  years  of  age,  became 
helpless  two  years  prior  to  her  death  from  a  stroke  of  paralysis. 
The  father,  age  unknown,  died  within  a  year  after  the  child's  birth 
with  tumor  of  the  stomach  accompanied  with  spasms.  A.  has  1 
sister  living,  said  to  be  normal. 

Case  F. — L.  M.  Male;  22  years  old;  a  mute,  nervous  and  rest- 
less. Very  unclean,  unable  to  wash,"  dress,  or  care  for  himself; 
gradually,  after  prolonged  care,  became  capable  of  self-help.  Fifth 
child  born  at  full  term.  Labor  ordinary.  Nourished  by  mother. 
Father  drank  moderately,  and  mother  was  a  moderate  smoker. 
There  were  2  children  still-born. 

Case  G. — J.  W.  Boy;  11  years  old.  Bright-faced,  well  formed 
and  physically  sound,  except  that  he  is  a  semi-mute.  Active, 
restless,  and  inquisitive,  snatching  at  everything  that  attracts  his 
attention.  Lawless  and  cruel  to  other  children.  At  4^  years, 
when  first  under  training,  was  never  quiet.  Has  learned  to  feed 
and  partially  dress  himself  and  has  become  more  cleanly  in  habits. 
Still  very  destructive,  tearing  and  chewing  his  clothes. 

Born  at  full  term  without  instruments;  nourished  by  mother 
who  was  22  and  the  father  26  at  time  of  birth.     The  father  de- 


2  54  ILLUSTRATIVE    CASES. 

serted  the  mother  in  the  early  months  of  pregnancy,  causing  her 
much  anxiety  and  forcing  her  to  seek  employment.  The  child  when 
a  baby  fell  in  a  coal-scuttle,  striking  his  head.  Both  father  and 
mother  were  drunkards. 

Case  H. — W.  H.  Boy;  16  years  old.  Nervous,  noisy,  although 
a  semi-mute.  In  training  class  learned  to  string  beads,  sew  cards, 
to  recognize  a  ball,  and  to  play  with  a  wagon.  Is  quarrelsome 
and  in  attacks  of  temper  will  tear  his  clothing  and  fight  other 
children,  becoming  more  destructive  and  violent  as  he  grows  older. 
Has  improved  in  habits  of  self-help.  Was  the  second  of  8  children, 
the  fifth  being  also  an  idiot.  Was  a  "  blue  baby."  Labor  difficult 
but  without  instruments.  Father  26  and  mother  21  at  time  of 
birth;  both  nervous  prior  to  child's  birth.  Mother  an  imbecile. 
Father  a  machinist  by  trade,  drank  moderately;  had  one  brother 
an  imbecile  epileptic,  and  two  other  brothers  who  died  of  consump- 
tion. Mother  was  subject  to  neuralgia,  and  her  sister  who  is  chor- 
eic, has  one  child,  a  mute. 

Case  I. — T.  H.  Boy ;  12  years  old,  a  semi-mute  (brother  of  W. 
H.).  Has  gradually  picked  up  disconnected  words  which  he  re- 
peats in  parrot-like  fashion.  Is  very  destructive,  tearing  and  chew- 
ing his  clothing  and  beating  himself.  Is  fond  of  playing  with  blocks 
and  balls,  but  is  cross  to  other  children.  Was  unclean  both  day  and 
night,  but  has  improved  in  habits  of  self-help.  The  fifth  child  born 
as  above  noted. 

Idio-Imbeciles. 

trainable  in  very  limited  degree  to  aid  in  care  of  others. 

Case  A. — W.  T.  Y.  Boy;  10  years  old  when  photograph  was 
taken.  Speaking  only  a  few  words,  but  understanding  simple  lan- 
guage; was  self-willed,  obstinate,  very  abusive,  quarreling  and 
fighting  with  other  children,  and  in  violent  temper  would  attack 
anyone.  Improved  in  self-help  and  cleanliness,  and  in  use  of  hands ; 
learning  to  knit,  became  a  dependable  aid  in  keeping  up  the  supply 
of  children's  caps.  Is  the  one  alluded  to  in  the  chapter  on  training, 
as  learning  first  to  tear  strips,  then  to  draw  threads  and  finally  to 
knit. 

Second  child,  labor  ordinary;  nourished  by  mother.  Father  35, 
mother  18  at  the  time  of  birth.  Father  smoked  and  drank  moder- 
ately. Condition  attributed  to  a  fall  and  concussion  of  brain  when 
two  years  old.     One  brother  and  two  sisters  living  and  healthy. 

Case  B. — J.  S.  Boy ;  aged  8  years ;  mute,  making  his  wants 
known  by  signs.  Had  bad  habits  when  he  entered  the  Training 
School,  but  in  three  years  had  improved  markedly,  becoming  quite 
helpful  in  dormitory  work,  running  errands,  etc.  Nothing  is  known 
of  family  history. 


IDIO-IMBECILES.  255 

Case  C. — L.  F.  Girl ;  7  years  old.  At  6  years  was  small  pale- 
faced  child  with  dark  hair  and  blue  eyes.  Very  little  power  of 
speech  and  enunciation  defective.  Understands  simple  language. 
Has  the  habit  of  "  Dervish  spinning  " — which  Dr.  S.  Weir  Mitchell 
describes  under  "  Rotary  Movements  " — when  she  will  twirl  on  her 
heels  for  25  minutes  without  stopping  and  then  reversing,  continue 
with  no  evidence  of  dizziness. 

Was  nervous  and  restless  in  school  and  occasionally  naughty. 
Was  very  obstinate,  but  has  improved  in  disposition  and  become 
cleanly  in  habits.  In  training  class,  learned  to  knit  and  sew  a  little. 
Can  plait  a  rope  mat  and  is  quite  helpful  in  dormitory  work.  Her 
chief  recreation  is  the  spinning  above  mentioned. 

First  child,  born  at  full  term,  ordinary  labor.  Nourished  by 
mother  for  3  months  and  then  by  maternal  grandmother  for  7.  Was 
a  sickly  child,  having  spasms.  Father  a  carpenter,  aged  30,  and 
mother  19  at  birth  of  child.  Father  addicted  to  the  use  of  tobacco 
and  liquor.  Mother  severely  abused  by  father.  L.  has  a  brother 
and  sister  living ;  the  sister  also  feeble-minded,  a  girl  of  high  grade. 
One  sister  died  in  convulsions.     Both  grandfathers  are  drunkards. 

Case  D. — S.  L.  Male ;  a  semi-mute,  aged  24  years,  very  clever 
in.  the  use  of  signs.  Thus,  he  describes  a  man  with  a  beard  by 
stroking  an  imaginary  beard,  with  his  hands ;  a  book-keeper,  by  the 
motions  of  writing,  and  a  boy  to  whom  he  has  taken  a  dislike,  by  put- 
ting his  hands  behind  his  ears  and  "  hehawing  "  like  a  donkey.  Was 
an  adroit  thief,  and  would  steal  anything  he  could  lay  his  hands  on. 
When  provoked,  bit  savagely.  Could  run  errands,  fetch  water  and 
became  an  excellent  outside  worker  with  pick  and  shovel,  over- 
exerting himself  unless  carefully  looked  after.  Was  pleased  with 
any  little  trifle  in  the  form  of  a  gay  ribbon,  a  cheap  pin,  a  bit  of 
candy,  etc. 

Family  history  negative. 

Case  E. — H.  L.  Boy ;  1 1  years  old  when  photograph  was  taken. 
Admitted  to  Training  School  when  5  years  old.  Blue  eyes,  light 
hair,  sight  and  hearing  defective.  A  semi-mute  speaking  only  a 
few  words.  Self-willed,  quick-tempered,  unable  to  care  for  him- 
self. Uncleanly  night  and  day.  Fond  of  music  and  of  animals. 
In  training  class,  made  some  little  progress ;  learned  to  comprehend 
what  was  said  to  him ;  to  put  nails  in  nail-board,  to  string  buttons 
and  beads,  and  to  follow  drill,  and  to  talk  a  little.  Improved  in  hab- 
its of  self-help  and  cleanliness,  and  became  quite  helpful  in  dormi- 
tory and  as  an  aid  in  care  of  other  children.  Nothing  known  of 
family  history. 


CHAPTER   XV. 

illustrative  cases  (continued). 

Imbeciles:   Low-Grade;  Middle-Grade;  High-Grade. 

Low-Grade  Imbeciles  :    trainable  in  industrial  and  simplest 
manual  occupations. 

Case  A. — S.  H.  Boy;  14  years  old.  Blue  eyes,  light  hair.  Sight 
and  hearing  good.  Speaks  in  broken  sentences.  Unable  to  wash 
and  dress  himself.  Cleanly  in  habits.  Entered  kindergarten  at  9 
years.  Was  fond  of  drawing  on  the  slate  but  slow  in  hand-work; 
restless  and  talkative.  Learned  to  dress  and  care  for  himself  and 
became  a  useful  aid  in  the  kitchen,  dormitory,  and  general  house- 
work. Eighth  child,  born  at  full  term,  ordinary  labor,  nourished  by 
mother.  Had  spasms  soon  after  birth.  Mother  extremely  nervous, 
was  overtaxed  in  mind  and  body  during  pregnancy.  Father  an  engi- 
neer, drank  and  suffered  from  neuralgia,  and  finally  became  insane. 
S.  has  1  brother  living  also  feeble-minded,  and  3  brothers  and  3 
sisters  dead. 

Case  B. — H.  H.  Boy;  13  years  old.  Has  a  bright  face  and  is 
well-formed.  Is  extremely  timid  and  easily  thrown  into  paroxysms 
of  fright.  Hands  and  feet  always  moist,  amounting  to  osmidrosis. 
Entered  school  in  his  eleventh  year,  but  made  little  progress  except 
that  he  learned  to  draw,  to  color  and  to  count,  and  improved  phys- 
ically from  the  drills.  Engaged  in  household  service,  is  a  good 
steady,  quiet  worker. 

Fifth  child,  born  at  full  term;  nourished  by  mother.  Father  a 
farmer,  33,  and  mother  30,  at  time  of  birth ;  2  brothers  and  3 
sisters  living,  sound  in  body  and  mind.  Paternal  grandfather  died 
of  consumption. 

Case  C. — A.  W.  Male ;  41  years  old.  Incapable  of  being  bene- 
fited by  school.  Made  a  fairly  good  farm  hand  and  was  contented 
and  happy.  Third  child,  born  at  full  term,  nourished  by  mother. 
Father  a  merchant,  a  drunkard  and  really  feeble-minded;  was  32 
and  mother  28  at  time  of  A.'s  birth,  prior  to  which  both  parents 
were  greatly  over-taxed.  Of  4  living  children,  beside  A.,  2  are 
feeble-minded.  A  child  died  of  meningitis.  The  mother's  3  sisters 
have  feeble-minded  children,  and  the  family  connection  shows  not  less 
than  82  insane  and  feeble-minded. 

256 


MIDDLE -GRADE   IMBECILES.  257 

Case  D. — P.  C.  Male;  31  years  old.  Ordinary  school  methods 
offering  practically  nothing  to  him,  his  training  has  been  purely  on 
industrial  lines.  A  skilled  worker  in  the  laundry,  is  neat  and  de- 
pendable in  household  service,  and  quite  deft  with  his  hands ;  does 
some  intricate  carving  in  his  own  peculiar  way.  An  adroit  thief,  he 
steals  simply  for  the  pleasure  of  stealing,  the  things  he  takes  being 
valueless  to  him.  Very  egotistic,  he  will  do  anything  to  attract 
attention;  thus,  some  years  ago  he  deliberately  jumped  into  a  vat 
of  lye,  and  was  quite  severely  burned,  losing  all  his  hair,  and  is  ex- 
tremely proud  of  his  bald  head.  Usually  affectionate  and  docile,  he  is 
at  times  stubborn  and  hard  to  manage.  Is  slow  to  anger,  but  has  a 
violent  temper  when  roused.    Family  history  unknown. 

Case  E. — C.  C.  Male;  21  years  old.  Large  and  overgrown;  really 
a  big  baby.  Halting  gait,  defective  articulation,  speaking  only  a  few 
words,  but  can  imitate  animal  cries.  Cleanly  in  habits,  improved 
in  self-help,  learned  to  do  a  little  housework  and  became  a  fairly 
good  worker.  Father  a  photographer,  aged  39,  and  mother  also  39, 
at  time  of  birth.  Eighth  child,  born  at  full  term,  ordinary  labor; 
nourished  by  mother.  Has  4  brothers  sound  in  mind  and  body. 
Maternal  grandfather  died  of  phthisis. 

Middle-Grade  Imbeciles  :    trainable  in  manual  arts  and 
simplest  mental  acquirements. 

Case  A. — A.  B.  Boy;  13  years  old.  A  type  of  many  to  be 
seen  every  day.  Black  hair  and  eyes,  clear  complexion.  Sight  and 
hearing  perfect.  Defective  articulation  and  limited  vocabulary,  but 
apt  in  using  signs.  Left-handed.  Affectionate  and  truthful,  is 
active,  fearless  and  heedless  of  danger.  Cleanly  in  habits,  recognizes 
primary  colors,  and  knows  alphabet.  Counts  readily  to  a  hundred. 
Can  wash,  dress  and  care  for  himself  in  every  way,  is  a  useful 
aid,  "and  finds  his  happiness  in  housework.  Under  special  training 
might  learn  to  read  and  write,  but  the  knowledge  would  be  of  no 
use  to  him.  Father,  a  farmer,  aged  31  and  mother  25,  at  birth  of 
child.  Born  at  full  term;  ordinary  labor;  second  child.  A  brother, 
1  year  old,  died  of  meningitis.    Paternal  grandparents  second  cousins. 

Case  B. — S.  Y.  Boy;  11  years  old.  Light  hair,  brown  eyes,  sight 
and  hearing  normal.  Well-formed.  Slight  difficulty  in  articulation, 
but  a  good  vocabulary.  Cleanly  in  habits;  could  wash,  dress,  and 
care  for  himself  and  do  simple  housework.  Knew  nothing  of 
alphabet,  but  could  count  very  well.  Entered  the  kindergarten  and 
did  good  work,  except  that  he  was  lazy  and  needed  constant  "  push- 
ing." Very  awkward  at  first  in  military  drill,  but  improving,  was 
promoted  and  became  an  orderly.    Approaching  the  age  of  puberty 

17 


258  ILLUSTRATIVE   CASES. 

he  became  obscene,  disobedient,  untruthful,  and  a  ring-leader  of 
disorder  in  his  club.  When  rebuked,  would  weep  copiously  and 
promise  not  to  offend  again,  but  would  immediately  disobey ;  his  sweet 
face  and  gentle  manner  would  frequently  deceive  those  in  charge. 
Later,  made  marked  improvement  and  became  an  interesting,  affec- 
tionate boy,  always  longing  for  and  dreaming  of  a  mother  whom 
he  found  eventually  after  many  years.  He  became  a  fair  musician 
and  a  good  tailor.  Father  an  insane  epileptic,  a  day-laborer,  was  30 
years  and  mother  25,  at  time  of  S.'s  birth. 

Case  C. — G.  G.  Boy;  imbecile,  about  19  years  old.  Was  dwarfed 
in  stature,  but  physically  well-formed.  Speech  fair  with  a  slight  Ger- 
man accent.  Learned  to  work  quite  well  on  the  farm  and  was  useful 
in  the  commissary  department,  distributing  provisions.  Disobedient, 
unreliable,  and  undependable.  Finally  found  his  father  and  went  out 
in  the  world  to  make  a  living ;  will  probably  drift  into  the  dependent 
ranks.    Almost  nothing  known  of  family. 

Case  D. — H.  B.  Boy;  19  years  old.  Red  hair,  blue  eyes,  and 
fair  complexion.  Came  to  Pennsylvania  Training  School  when  about 
10  years  old ;  was  quite  a  bright  boy  in  many  ways ;  went  to  school 
regularly,  learned  to  read  and  write,  could  sing,  was  fond  of  animals, 
and  became  very  useful  as  an  aid  in  the  kitchen  and  in  dormitory 
work.  Was  untruthful,  erratic,  dishonest  and  unreliable,  but  not  a 
moral  imbecile.  Second  child;  born  at  full  term;  ordinary  labor; 
nourished  by  mother,  who,  an  imbecile,  was  between  21  and  24  years 
of  age  at  time  of  child's  birth.  Mother  was  scrofulous,  and  child  also 
in  a  marked  degree.  Child  was  illegitimate,  and  the  woman's  father, 
who  was  a  drunkard,  is  supposed  to  be  the  father  of  the  child. 

Case  E. — F.  B.  Boy;  9  years  old.  At  5  years,  was  small,  well- 
formed,  light  hair,  blue  eyes ;  was  cleanly  in  habits,  and  spoke  quite 
distinctly.  Gentle,  obedient,  quiet,  indolent;  absolutely  without 
fear.  Powers  of  attention,  imitation,  and  memory  fair.  In  school 
learned  to  read,  write  and  cipher,  and  was  excellent  in  military  drill. 
Later  became  restless  and  erratic,  and  having  reached  his  limit  in 
school,  was  finally  taken  out  as  an  aid  in  the  sewing  room  and  laun- 
dry, where  he  distributes  clothing,  darns  stockings,  runs  errands,  etc., 
always  under  supervision.  Almost  nothing  is  known  of  family  his- 
tory, except  that  the  father  was  a  janitor  in  the  alms-house. 

Case  F. — C.  P.  Girl ;  9  years  of  age.  Light  hair  and  gray  eyes, 
near-sighted,  but  hearing  good.  Imperative  movements  of  head — 
myospasmus.  Learned  to  read  and  write,  and  use  her  hands,  and 
made  marked  improvement,  but  is  phthisical  and  very  delicate. 

Father,  a  miner,  aged  21  years  and  mother  30,  when  child  was 
born. 

Case  G. — J.  N.     Boy ;  14  years  old  when  photograph  was  taken. 


MIDDLE-GRADE    IMBECILES.  259 

Strong  and  healthy.  Dark  skin,  black  eyes,  and  freckled  face. 
Read  simple  sentences  very  well,  and  wrote  words  of  two  and  three 
letters ;  could  count  and  make  figures  fairly  well.  Was  very  trouble- 
some, disobedient,  and  a  trial  to  every  one  with  whom  he  came  in 
contact.  Made  marked  improvement  in  school ;  learning  to  knit  and 
sew  and  to  play  very  well  on  the  cornet,  but  lacked  application,  and 
was  erratic  and  lazy.  Did  well  in  military  drill,  but  finally  became 
so  rough  with  the  other  children  that  he  was  transferred  to  stable 
work,  where  he  seemed  to  be  in  his  element.  Made  an  excellent 
groom  and  stable  boy,  and  gave  not  the  slightest  trouble.  In  his 
seventeenth  year  was  removed.  During  the  Spanish-American  War, 
he  entered  the  army,  served  with  credit,  and  was  honorably  dis- 
charged.    Nothing  is  known  of  family  history. 

Case  H. — J.  M.  Boy ;  aged  9  years.  Came  to  us  when  5  years 
old,  a  light-haired,  blue-eyed  baby  in  dresses.  Began  to  string  beads 
and  to  play  with  buttons.  Sent  first  to  kindergarten,  and  then  to 
school ;  continued  to  improve,  learning  to  read  and  write  fairly  well. 
Is  now  19  years  old,  has  made  steady  progress  and  is  a  useful  or- 
derly in  the  hospital.  A  waif  and  stray ;  nothing  is  known  of  family 
history. 

Case  I. — W.  M.  Boy;  17  years  old.  Light  hair,  blue  eyes,  sight 
and  hearing  perfect,  but  speech  slightly  defective,  and  vocabulary 
limited.  Had  spasms  at  one  and  a  half  years.  These  continued 
until  he  was  4  years  old  and  then  ceased.  Occasionally  unclean 
at  night.  Fond  of  children,  music,  animals,  but  knew  nothing  of 
color  and  form ;  went  regularly  to  school  and  made  some  little  im- 
provement. Learned  to  read  and  could  write  a  fair  letter.  Worked 
on  the  farm  and  was  a  good  milker,  trucker,  etc.  Is  now  making 
an  honest  living  at  good  wages. 

Third  child ;  prolonged  labor ;  nourished  by  mother,  who  during 
gestation  was  over-worked  and  sustained  a  severe  fall.  Father  a 
house-painter,  aged  26,  and  mother  28,  at  time  of  child's  birth. 
Paternal  grandfather  died  of  phthisis. 

Case  J. — J.  B.  Boy;  aged  14  years.  Small,  red-faced,  hearing  and 
gait  good,  but  slow  in  movements;  sight  imperfect;  eyes  are  rather 
small  and  weak.  At  9  years  could  talk  very  little.  Sent  regularly  to 
school  and  did  excellent  work.  Was  trustworthy,  but  at  times  ob- 
stinate and  disobedient,  and  would  fly  into  a  temper  on  slight  provo- 
cation. Upon  reaching  his  limit  in  school  he  was  placed  in  tailor 
shop,  for  which  work  he  displayed  a  decided  aptitude,  making  but- 
ton-holes, and  using  the  sewing-machine;  was  also  a  useful  aid  in 
dining-room  and  dormitory.    Nothing  is  known  of  family. 


26o  illustrative  cases. 

High-Grade  Imbeciles  :   trainable  in  manual  and 
intellectual  arts. 

Case  A. — A.  S.  Boy;  aged  16  years,  with  the  intelligence  of  a 
normal  child  of  12.  Powers  of  attention  and  imitation  fair.  Excel- 
lent memory.  Does  not  care  for  study,  but  is  fond  of  reading  boys' 
books.  Has  a  clear  high  tenor  voice  and  is  interested  in  athletics. 
Clever  with  his  hands — a  ready  type-setter ;  a  good  cornetist  and  fond 
of  active  employment.  Obedient  and  affectionate,  is  a  remarkably 
clean-minded,  wholesome  boy,  with  an  attractive  personality. 

Father,  a  printer,  aged  28,  and  mother  25,  at  time  of  child's  birth. 
Second  child ;  born  at  full  term ;  difficult  labor ;  fed  artificially ; 
sickly  infant.  Mother  much  prostrated  in  fifth  month  of  gestation, 
by  death  of  brother.     Father  died  of  phthisis. 

Case  B. — M.  S.  Female;  aged  20  when  photograph  was  taken. 
Brown  hair  and  eyes.  Sight  slightly  defective.  Distinct  enuncia- 
tion and  excellent  vocabulary ;  can  read  and  write ;  is  very  deft  with 
her  hands — excellent  in  sloyd  work,  embroidery,  a  good  seamstress 
and  housemaid.     Father  a  laborer,  and  below  par  mentally. 

Case  C. — H.  R.  Boy ;  5  years  old.  A  perfect  baby  in  every  way. 
Can  speak  only  a  few  words,  but  understands  all  that  is  said  to  him. 
Powers  of  attention,  imitation,  and  memory  all  good.  At  two  and 
one  half  years  was  unable  to  do  anything  for  himself.  Sent  to 
kindergarten,  has  become  interested,  learning  to  sort  colors,  weave 
mats,  lace  cards,  march,  and  has  added  to  his  vocabulary  and  sings 
quite  well.  Occasionally  obstinate,  is  generally  obedient  and  man- 
ageable.    Nothing  known  of  family  history. 

Case  D. — J.  A.  Boy ;  aged  1 1  years.  A  very  delicate  child, 
sweet-faced  and  serious,  rather  tall,  with  blue  eyes,  light  hair,  and 
heavy  eyelids,  good  strong  hands  and  a  steady  gait.  Speech  quite 
imperfect.  Is  cleanly  in  habits.  Had  epilepsy  from  fifth  month  to 
third  year,  but  no  attacks  since.  In  his  ninth  year,  he  knew  but 
little.  Two  years  under  special  training,  made  wonderful  progress 
in  reading,  writing,  and  arithmetic.  Not  truthful  nor  altogether 
honest ;  obstinate  and  occasionally  difficult  to  control  in  school. 

Father,  a  carriage  painter,  aged  24  years  and  mother  23,  at  the 
time  of  child's  birth.  First  born ;  ordinary  labor ;  mother  was  wor- 
ried all  during  pregnancy. 

Case  E. — V.  D.  M.  Boy;  aged  12  years.  Light  brown  hair, 
blue  eyes,  and  fine  teeth.  Speech  perfect;  near-sighted.  When  six 
years  old,  knew  alphabet  and  could  count  to  fifty,  and  sang  all  the 
popular  songs.  Powers  of  attention,  imitation,  and  memory  good. 
Was  a  very  slow  child  and  needed  special  training.  A  gentle,  lovable 
boy  whose  pleasant  ways  and  affectionate  disposition  made  him  a 


HIGH-GRADE    IMBECILES.  26 1 

favorite  with  everyone.  Was  extremely  generous.  In  kindergarten, 
his  hand-work  was  beautiful.  Learned  to  read,  write,  draw,  and  to 
embroider.  Improved  steadily;  developed  a  clear  tenor  voice,  and 
was  a  fair  violinist. 

Father  was  a  gilder,  aged  40  and  mother  32  at  time  of  V.'s  birth. 
Was  the  second  child,  ordinary  labor,  and  has  a  brother  also  feeble- 
minded. Mother  a  neurotic.  Paternal  grandfather  and  paternal 
grandmother  both  died  of  phthisis.  Maternal  grandfather  died  of 
congestion  of  the  brain. 

Case  F. — R.  E.  Boy ;  12  years  old  when  photograph  was  taken. 
Well-formed,  sight  and  hearing  slightly  defective.  Was  a  dreamy 
boy,  with  a  peculiar  stubborn  disposition,  somewhat  lazy,  but  inter- 
ested in  certain  things.  Did  well  through  primary-school  course. 
Learned  to  read,  and  to  write  a  good  letter.  Developed  decided  talent 
for  music ;  had  a  good  baritone  voice  and  played  well  on  both  trom- 
bone and  baritone  horn.  Trained  in  carpentry,  was  slow  but  neat, 
and  did  excellent  work.  Absolutely  truthful  and  trustworthy ;  de- 
veloped a  gentle  and  lovable  disposition.  Very  sensitive,  and  resent- 
ing any  supposed  slight,  when  once  he  took  a  dislike,  did  not  easily 
overcome  the  prejudice.  Remarkably  successful  in  the  cultivation 
of  flowers,  showed  considerable  ability  as  a  gardener.  When  22 
years  old  he  went  out  into  the  world,  and  has  made  an  excellent  liv- 
ing, utilizing  all  his  acquirements  as  carpenter,  florist,  and  musician. 
Nothing  is  known  of  family  history  except  that  his  father  was  a 
drunkard. 

Case  G. — O.  F.  Male;  21  years  old  when  photograph  was  taken. 
Came  to  us  in  his  sixteenth  year,  a  strong,  healthy  boy,  brown  hair 
and  blue  eyes,  good  figure,  wrote  a  very  good  hand  and  could  read, 
although  he  did  not  care  for  books.  Was  a  most  consummate  liar, 
an  egotist,  fond  of  telling  stories  of  his  own  achievements ;  he  could 
not  lie  logically,  however,  and  would  break  down  when  cornered. 
A  bully  and  a  coward.  He  had  delusions,  imagining  himself  at  one 
time  a  detective.  Was  fond  of  military  drill  and  eventually  be- 
came a  captain  in  our  military  company.  Fond  of  music,  had  quite 
a  good  voice,  practiced  for  a  while  on  the  cornet,  but  losing  interest, 
gave  it  up.  Had  had  some  training  as  a  baker  in  an  orphanage 
which  training  continued  with  us.  He  became  in  his  twenty-sixth 
year  our  head  baker  with  5  boys  under  him,  of  which  he  was  very 
proud.  Did  excellent  work  for  a  while,  using  not  less  than  30  bar- 
rels of  flour  a  week. 

One  Christmas  morning,  being  enraged  with  the  housekeeper  for 
some  trifling  cause,  he  put  out  all  the  fires,  delaying  the  house  move- 
ment for  the  entire  day.  Losing  interest  after  this,  and  neglecting 
his  work,  he  was  transferred  to  the  carpenter  shop,  where  he  did 


262  ILLUSTRATIVE    CASES. 

very  well.  Going  out  in  his  thirtieth  year,  he  worked  at  his  old 
trade  for  a  season  at  one  of  the  summer  resorts,  and  in  a  few  months 
saved  and  invested  $70. 

Has  now  entered  the  Marine  Service,  and  is  doing  well. 

Second  child;  born  at  full  term;  ordinary  labor.  Mother,  much 
worried  during  the  last  3  months  of  pregnancy,  and  nursing  her 
mother,  was  overtaxed  in  body  and  mind.  Died  3  years  later  of 
phthisis.  Father  was  28  and  mother  26,  at  time  of  O.'s  birth.  The 
maternal  grandfather  was  a  drunkard ;  the  paternal  grandfather,  who 
died  of  phthisis,  had  an  insane  brother. 

Case  H. — L.  H.  Boy;  aged  13  years  when  photograph  was 
taken.  Came  under  my  care  at  10  years.  A  delicate  child,  needing 
careful  attention.  Brown  hair  and  dark  eyes.  Was  near-sighted 
and  slightly  deaf.  Slow  mentally,  yet  under  training  he  accom- 
plished in  10  years  the  ordinary  school  intermediate  course,  and 
gained  considerable  proficiency  also,  in  free-hand  drawing,  in  water 
color,  in  designing,  and  in  wood  carving.  Did  beautiful  work  in 
sloyd,  building  and  carving  furniture — chairs,  tabourettes,  etc. 
Fond  of  music,  became  an  excellent  violinist.  A  fair  mechanic,  is 
now  earning  a  good  living. 

Only  child;  born  at  full  term;  ordinary  labor.  Was  unusually 
small  at  birth. 

Father  a  drunkard,  and  treating  his  wife  badly,  was  25,  and 
mother  26,  at  time  of  child's  birth.  Mother  working  hard,  had  much 
anxiety  during  gestation.     Phthisis  heredity  in  family. 

Case  I. — G.  B.  Boy;  came  to  us  a  bright  little  fellow  of  eight 
years,  who  had  received  some  training  in  a  day-nursery  kinder- 
garten, but  got  more  on  the  streets.  Powers  of  attention,  imitation, 
and  memory  excellent.  Had  a  good  singing  voice,  a  clear  treble,  and 
sang  all  the  songs  of  the  day.  Was  erratic,  restless,  and  it  was  very 
difficult  to  keep  him  interested  in  anything  for  more  than  a  few 
moments  at  a  time.  Incapable  of  fear,  always  eager  for  a  fight, 
would  attack  a  boy  twice  his  size.  Knew  alphabet,  and  recognized 
color  and  form,  and  could  draw  well.  Cleanly  in  habits  and  capable 
of  self-help.  Was  obstinate,  passionate,  vulgar  and  profane.  Re- 
sponding gradually  to  refined  environment,  did  excellent  work  in  the 
kindergarten,  learning  to  march,  to  read,  and  to  write  fairly  well,  in 
two  years.  Transferred  to  school,  is  quick  to  grasp  and  to  under- 
stand. Is  learning  to  control  temper,  is  very  affectionate  and  clean, 
and  seems  to  have  forgotten  much  of  his  old  vulgarity  and  profanity. 

Seventh  child,  born  at  full  term ;  ordinary  labor ;  fed  artificially. 
Father  a  laborer,  aged  32,  and  mother  same  age,  at  time  of  child's 
birth.  Phthisis  in  father's  family.  The  mother  a  most  immoral 
woman ;  a  street  walker.     Environment  the  very  worst — the  entire 


Plate  XLV 


inj^u 

X  x^ 

■i^ml< 

HIGH-GRADE    IMBECILES.  263 

family  living  in  a  room  twelve  by  fifteen,  its  only  window  opening  into 
a  narrow  dark  passage.  Mother  and  father  both  drunkards ;  mother 
would  pawn  or  sell  children's  clothing  given  in  charity,  to  obtain 
liquor.  Mother  and  oldest  sister  were  sent  to  House  of  Correction 
for  administering  "  knock-out  drops  "  to  a  man.  The  girl,  aged 
fourteen,  told  how  she  could  decoy  a  man  into  the  room,  drop  the 
chloral  or  "  snuff  "  into  his  beer  or  whiskey,  and  then  go  through 
his  pockets,  knowing  just  where  men  usually  keep  their  money. 

A  brother  and  2  sisters  living — 1  sister  a  low-grade  imbecile  and 
the  other  a  moral  imbecile. 

Case  J. — J.  A.  G.  Boy;  aged  10  years.  Brown  hair  and  eyes. 
Sight  and  hearing  normal.  Could  read,  write,  and  cipher  and  recog- 
nize color  and  form.  Tidy  in  dress  and  cleanly  in  habits.  Powers 
of  attention,  imitation,  and  memory  fair.  Did  excellent  work  in  the 
kindergarten.  Had  defective  articulation,  substituting  f  for  p,  saying, 
for  instance  "  flease  "  for  please,  and  dropping  r,  as  in  "  dink  "  for 
drink.  Was  lazy  and  inattentive,  but  has  a  talent  for  drawing  and  is 
now  making  marked  improvement. 

First  born  of  twins;  labor  ordinary;  fed  artificially;  mother  de- 
ficient mentally,  has  an  epileptic  brother.  Father,  a  railroad  man, 
aged  26  and  mother  25  at  time  of  A.'s  birth. 


CHAPTER   XVI. 

illustrative  cases  (continued) .    Moral  Imbeciles. 

Low-Grade  Moral  Imbeciles  :  trainable  in  industrial  occupa- 
tions.    Temperament  bestial. 

Case  A. — H.  T.  Boy;  aged  15  years,  dark  brown  hair  and  eyes. 
Speaks  but  a  few  words,  and  enunciation  very  imperfect.  Choreic 
movements  of  hands  and  face.  Had  epilepsy  when  4  months  old; 
spasms  lasted  until  sixth  year,  and  then  began  to  diminish  in  force 
and  frequency,  only  to  grow  more  severe  again.  Sent  to  school. 
Learned  to  match  colors,  and  sew  cards ;  a  ready  helper  in  arranging 
material,  quick  to  learn  the  proper  places  for  things.  Caught  a  tune 
easily  and  sang  the  songs,  but  with  very  imperfect  words.  Became 
so  quarrelsome  that  he  could  not  be  kept  in  school — biting,  scratching, 
and  fighting;  had  a  habit  of  kicking  children  in  the  stomach  and 
struck  a  blow  like  a  sledge-hammer.  Was  an  adroit  thief,  stealing 
in  the  most  ingenious  manner.  Most  immoral  in  every  way  and  had 
to  be  kept  in  restraint  much  of  the  time.  Learned  to  do  simple  house- 
work very  well,  but  became  so  violent  and  dangerous  that  he  was 
transferred  to  an  insane  hospital. 

Father  a  very  passionate  man ;  mother  extremely  nervous ;  had 
two  miscarriages;  H.  born  at  full  term,  ordinary  labor.  Father,  a 
shoemaker,  aged  24  and  mother  20,  at  time  of  child's  birth. 

Case  B. — D.  T.  Boy;  12  years  old;  epileptic,  ignorant,  undis- 
ciplined, and  a  runaway.  Has  no  respect  for  anything  or  anybody. 
Language  and  actions  most  foul  and  vile,  of  which  there  are  frequent 
outbreaks,  without  the  slightest  provocation.  Can  sing  a  few  vulgar 
songs.  Is  a  great  egotist ;  hard  to  manage,  brutal  and  cruel  to  other 
children;  destructive,  a  liar,  and  a  thief.  Unable  to  read  or  write. 
Can  render  slight  assistance  in  dormitory  work. 

Father,  a  Welsh  miner,  aged  27,  and  mother  34,  at  time  of  D.'s 
birth.    Mother  and  one  sister  died  of  phthisis. 

Case  C. — W.  J.  F.  Boy ;  aged  1 1  years ;  small  for  his  age,  epi- 
leptic, untruthful,  vulgar,  profane,  cruel  and  brutal ;  an  adroit  thief. 
Heedless  of  danger  and  insensitive  to  pain,  he  climbed  out  of  a  third- 
story  window  and  fell  to  the  ground,  striking  his  head,  but  was  only 
slightly  stunned.  Knew  alphabet,  and  could  sing,  dance,  and  pray; 
would  repeat  long  Latin  prayers,  cross  himself,  and  make  vulgar 
remarks  and  swear,  almost  in  the  same  breath.     Absolutely  devoid 

264 


LOW-GRADE    MORAL   IMBECILES.  265 

of  the  moral  sense,  it  was  impossible  to  teach  him  to  obey  or  to  keep 
him  out  of  mischief. 

Fourth  born,  at  full  term  and  in  ordinary  labor;  nourished  by 
mother.  Has  4  brothers  and  1  sister  living.  Father  a  gas-fitter,  was 
30  years  of  age,  and  mother  25,  at  birth  of  child.  Mother's  2  sisters 
died  of  phthisis. 

Case  D. — A.  S.  Male ;  aged  22,  with  a  deprecating  almost  pathetic 
expression  of  countenance,  soft  voice  and  gentle  confiding  manner. 
A  sneak,  and  absolutely  untrustworthy.  When  fully  aroused,  may  be 
violent  and  even  dangerous.  An  excellent  worker  in  dining-room 
and  laundry,  understanding  thoroughly  the  machines  in  use.  An 
adroit  thief  and  an  accomplished  liar.  On  one  occasion  when  he 
was  preparing  for  a  visit  home,  a  twenty-dollar  note  belonging  to 
one  of  his  attendants  disappeared.  Prior  to  leaving  the  house  the 
boy  was  carefully  searched  but  nothing  was  found.  Within  ten 
minutes,  on  his  way  to  the  station,  he  was  recalled  for  another  ex- 
amination and  stripped  to  his  shoes  and  stockings,  I  even  running 
my  hands  over  the  latter  without  detecting  anything.  As  he  left  the 
room,  with  tears  and  protestations  of  innocence,  he  could  not  resist 
giving  me  a  sly,  shifting  look,  and  a  glance  at  his  leg.  Turning  down 
the  stocking,  there,  plastered  to  the  leg,  the  money  was  found. 

Stamps,  paper,  pens,  and  pen-holders  disappeared  from  my  desk 
and  could  not  be  traced.  Some  eight  years  after,  searching  his  box 
for  something,  these  were  found  securely  packed  away  under  a  false 
bottom.  The  singular  part  of  it  all  was  that  my  office  was  inacces- 
sible, and  in  all  these  years  he  never  had  been  seen  anywhere  in  the 
building.    These  are  only  examples  of  his  many  depredations. 

Family  history  indefinite,  except  that  the  father,  an  old  man  who 
had  married  a  young  imbecile  woman  died  of  old  age  2  years  after 
child's  birth.  The  boy  himself,  when  2  years  of  age,  was  run  over 
by  a  street  car. 

Case  E. — R.  W.  Boy ;  14  years  old.  Under  training  became  quite 
efficient  in  household  service;  but  disobedient,  hard  to  manage,  and 
an  incorrigible  thief,  stole  even  from  himself.  Thus,  some  years  ago 
he  came  into  possession,  to  his  great  delight,  of  a  toy — a  little 
rubber  toad.  In  a  few  minutes  however,  the  toy  disappeared.  He 
screamed,  cried,  and  protested  that  some  one  had  stolen  it.  Upon 
investigation  it  was  discovered  securely  tucked  away  in  his  glove. 
He  had  secreted  it — stolen  it  from  himself — simply  to  create  excite- 
ment. 

R.  was  born  at  full  term;  ordinary  labor.  There  were  4  or  5 
children ;  2  sisters  living ;  I  boy  next  older  than  R.,  an  idiot,  was 
killed  by  the  cars.  Mother,  imbecile,  45  when  child  was  born ;  father, 
a  day  laborer,  age  unknown.    Mother  had  2  feeble-minded  sisters,  1 


266  ILLUSTRATIVE    CASES. 

of  whom  had  an  illegitimate  feeble-minded  son,  whose  father  was 
also  feeble-minded. 

Case  F. — J.  D.  Boy;  15  years  old.  Both  sight  and  hearing  good, 
but  articulation  poor.  Sly,  stubborn,  with  violent  temper;  cruel  and 
brutal  to  other  children.  Did  excellent  work  in  the  kindergarten,  and 
in  training  class  learned  to  use  his  hands,  to  knit  and  to  cane  chairs. 
An  adroit  thief,  unmanageable,  gave  trouble  to  every-  one  with  whom 
he  came  in  contact.     Family  history  unknown. 

Case  G. — I.  D.  Boy ;  14  years  old,  a  brother  to  the  foregoing  boy. 
Improved  considerably  under  training  in  hand-work ;  learned  to  knit 
quite  well  and  assist  in  dormitory,  but  was  profane,  vulgar,  brutal, 
cruel  to  the  other  children  and,  like  his  brother,  a  constant  source 
of  trouble. 

Case  H. — G.  A.  Boy ;  aged  10  years  when  photograph  was  taken. 
An  adroit  thief,  an  accomplished  liar,  brutal,  cruel,  and  dangerous 
to  smaller  boys.  In  training  class  learned  to  knit  and  darn  stockings. 
Was  very  deft  with  hands  but  too  dangerous  a  character  to  be  trusted 
with  tools.  Could  pick  any  lock.  Under  supervision  was  fairly  good 
at  both  farm  and  house-work. 

Enticed  away  at  18  years,  he  disappeared  for  5  years,  and  drifting 
from  farm  to  farm,  giving  unlimited  trouble,  finally  in  a  spirit  of 
revenge,  set  fire  to  a  barn  and  was  arrested.  During  trial  he  con- 
fessed to  no  less  than  50  burglaries,  many  of  which  had  for  a  long 
time  baffled  the  detectives. 

A  waif  and  stray ;  nothing  is  known  of  family  history. 

Middle-Grade  Moral  Imbeciles  :   trainable  in  industrial  and 
manual  occupations.    plotters  of  mischief. 

Case  A. — T.  F.  Boy;  aged  13  years.  Brown  hair  and  eyes  and 
prominent  teeth ;  enunciation  distinct  and  good  vocabulary.  Chor- 
eic movements  of  face.  Had  spasms  when  three  years  old,  but  none 
since.  Cleanly  in  habits.  Powers  of  attention  and  imitation  fair. 
Memory  poor.  Recognizes  form  and  color ;  can  read  and  count  a 
little.  Capable  of  self-help  and  can  aid  in  dormitory.  In  training 
class  learned  to  knit  intricate  patterns  which  fortunately  keeps  his 
mischievous  fingers  employed.  Absolutely  without  affection,  he 
is  vicious,  vulgar  and  brutal,  delighting  in  screaming  and  yelling  at 
top  of  his  voice  for  hours.  An  adroit  thief  and  a  clever  schemer, 
he  tells  lies  with  such  an  air  of  truth  that  it  is  hard  not  to  credit 
what  he  says.  We  have  not  attempted  to  educate  him,  assured  that 
every  mental  acquirement  would  be  prostituted  to  evil  purposes,  and 
there  is  no  hope  of  reformation,  for  there  is  no  moral  sense  to  appeal 
to. 


Plate  XLVI. 


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f 

■              '  '  "    w 

fct  /  .-- 

m  ,     ^**m 

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w 

jm* 

11     1 

H 

INSANITY. 


MIDDLE-GRADE    MORAL   IMBECILES.  267 

First-born,  nourished  by  mother.  Father,  a  tailor,  aged  23,  and 
mother  25,  when  child  was  born.  Maternal  grandfather  died  of 
phthisis. 

Case  B. — M.  T.  Boy ;  1 1  years  old.  Bright  in  many  ways,  but 
impertinent,  vulgar,  obscene,  and  hard  to  manage.  Recognized 
color  and  form,  but  knew  nothing  of  the  alphabet.  Said :  "  There's 
something  in  my  brain  that  keeps  me  from  getting  smart."  Given 
a  fair  trial  in  kindergarten,  was  so  brutal  to  little  children  that  he 
had  to  be  removed.  In  the  school  he  proved  an  element  equally 
disturbing,  using  everything  he  gained  as  an  instrument  of  ill;  the 
more  he  knew  the  worse  he  grew,  becoming  absolutely  lawless  and 
incorrigible. 

Epilepsy  also  developed  and  with  recurrence  of  spasms,  his  attacks 
of  temper  became  so  violent  as  to  necessitate  removal  to  strict  cus- 
todial care,  to  prevent  him  harming  himself  and  others. 

Third  child ;  born  at  full  term ;  difficult  labor,  but  no  instruments. 
Has  2  brothers  and  1  sister  living,  normal.  Father,  an  engineer,  a 
dipsomaniac,  aged  34,  and  mother  25,  when  M.  was  born. 

Case  C. — S.  G.  Boy ;  aged  10  years  when  photograph  was  taken. 
Stout  and  sturdy  build.  Head  rather  large.  Blue  eyes  and  light 
hair;  sight  and  hearing  good,  but  speech  imperfect.  Quite  affec- 
tionate, but  untruthful  and  untrustworthy.  In  kindergarten,  learned 
to  use  his  hands  quite  well,  and  to  read,  but  was  lazy,  inattentive, 
disobedient,  and  sullen.  Transferred  to  school,  improved,  but  teased 
the  younger  children.  Trained  in  housework,  began  to  steal,  putting 
the  blame  always  most  adroitly  on  another.  Articulation  improved, 
acquired  an  excellent  vocabulary,  and  developed  a  good  singing 
voice;  learned  to  play  on  cornet,  and,  a  member  of  the  band,  be- 
came less  sullen  and  appeared  to  improve  morally.  At  16  years 
of  age  the  cloven  foot  again  began  to  show  itself,  and  once  more  he 
was  lazy,  disobedient,  dishonest,  and  untruthful,  and  in  addition  he 
became  a  sexual  pervert,  in  filthy  practices  utterly  shameless.  Tried 
in  various  trades,  he  did  very  well  in  cooking-class,  and  as  a  kitchen 
scullion.  Deft  with  hands,  he  proved  in  turn  a  fair  baker,  tailor, 
gardener  and  house  painter ;  but  everywhere  lazy,  untrustworthy, 
and  tricky,  was  finally  transferred  to  a  custodial  building.  Here, 
absolutely  ammoral,  his  record  at  the  end  of  three  years  is  "  a  moral 
imbecile  of  the  most  pronounced  type,  of  middle  grade ;  an  accom- 
plished liar,  an  adroit  thief,  a  sexual  pervert,  brutal  and  cruel  in 
every  respect."  This  at  19  years  of  age.  His  capabilities  as  an  aid 
had,  notwithstanding  this,  gradually  procured  for  him  a  certain 
amount  of  liberty,  although  under  general  supervision. 

This  same  year  a  fire  occurred,  evidently  the  work  of  an  incen- 
diary ;  a  large  barn  filled  with  hay  in  close  proximity  to  the  build- 


268  ILLUSTRATIVE   CASES. 

ings.  The  children  gathered  in  the  large  hall,  were  engaged  in  their 
evening  games,  when  S.  suddenly  ran  in  and  gave  the  alarm  of  fire. 
The  larger  boys,  quickly  detailed  as  a  bucket  brigade,  rendered  effi- 
cient service.  In  the  midst  of  the  excitement  as  I  passed  S.  he  gave 
me  a  furtive  glance  and  stepped  back  with  an  air  of  concealment 
which  aroused  my  suspicions,  as  there  was  no  reason  why  he  should 
have  avoided  me.  The  following  day  one  of  the  men  told  me  that 
he  had  seen  S.  near  the  barn  just  before  the  alarm  was  given.  In- 
terrogated, the  boy  denied  all  knowledge  of  the  affair,  first  weeping 
and  then  indignant  that  he  should  be  suspected.  His  vociferous  de- 
nials however,  had  not  the  ring  of  truth,  so  I  placed  him  in  a  room  ad- 
joining that  of  a  comrade  and  stationed  an  employee  on  guard  to 
await  developments.  The  confession  was  overheard:  how  he  had 
found  an  explosive  match — probably  dropped  by  a  chance  visitor ; 
how  he  had  guarded  it  for  days,  and  finally  watching  his  opportu- 
nity, struck  it  and  threw  it  in  the  barn,  fanned  the  flame  and  closed 
the  door  when  the  hay  began  to  burn ;  how  he  then  sat  on  the  bank 
until  he  was  sure  it  was  well  ablaze,  and  then  gave  the  alarm. 
When  confronted  with  his  statement,  he  broke  down  and  made  a 
full  confession.  Removed  to  an  insane  hospital,  he  was  after  sev- 
eral years  released,  and  is  now  a  tramp,  capable  of  perpetrating  any 
act  of  violence. 

The  boy  was  a  foundling;  the  mother,  feeble-minded,  disappeared 
after  leaving  him  at  a  charitable  institution. 

Case  D. — H.  P.  Boy;  13  years  old.  Capable  of  discriminating 
between  right  and  wrong,  but  generally  prefers  wrong.  Restless 
and  undisciplined  to  the  verge  of  savageness.  An  ego-maniac,  will 
scratch  and  bite  himself  to  create  sympathy,  and  will  do  anything 
to  attract  attention,  especially  in  the  presence  of  strangers ;  will  often 
throw  up  his  hands  and  say,  with  the  tears  he  can  always  summon 
at  will :  "  Oh  Doctor,  I  do  want  to  be  liked  "  ;  in  another  minute  he 
will  be  laughing.  Has  the  nasty  habit  of  spitting  on  his  hands  and 
rubbing  them  over  his  face.  A  lord  of  misrule  in  the  school,  he  was 
transferred  to  a  custodial  building.  Here  with  less  to  excite  him, 
he  has  improved  mentally;  learned  to  knit  caps,  scarfs,  and  shawls, 
but  will  destroy  them  if  not  watched.  A  desperate  liar,  an  adroit 
thief,  a  clever  pick-pocket,  and  a  mischief-maker,  he  is  always  fight- 
ing. Cruel,  brutal,  and  extraordinarily  jealous,  he  is,  when  roused, 
very  dangerous  to  other  children.  Ordinarily  defiant,  impudent,  and 
disobedient,  he  can  be  at  times  sweet-mannered  and  engaging,  but 
his  moods  change  quickly  and  he  is  treacherous  and  untrustworthy. 
His  teacher  one  day  charged  him  with  a  message  to  his  attendant 
to  the  effect  that  for  some  misdemeanor,  he  was  to  be  disciplined  by 
having  only  bread  and  milk  for  his  dinner.     Knowing  the  woman 


MIDDLE-GRADE    MORAL    IMBECILES.  269 

to  be  devoted  to  birds,  he  told  her  that  the  teacher  had  sent  her  word 
that  she  had  a  beautiful  bird  in  a  wire  cage  for  her,  and  went  on  to 
describe  both  cage  and  bird  so  graphically  that  she  gave  him  an 
extra  good  dinner  for  his  good  news.  When  confronted  by  his 
teacher  and  the  woman  to  whom  he  had  lied,  he  denied  point  blank 
ever  having  delivered  any  such  message ;  nor  could  threats  or  bribes 
bring  him  to  a  confession. 

A  knowledge  of  reading  and  writing  would  materially  increase  his 
power  of  evil  doing.  A  capable  worker,  either  as  a  farm  laborer  or 
in  household  service,  he  will  nevertheless  always  be  a  fire-brand, 
wherever  placed,  and  should  always  be  under  strict  custodial  care. 

Third  child  born ;  nourished  by  mother ;  difficult  labor  with  in- 
struments. Both  parents  imbecile  and  intemperate.  Father,  a  la- 
borer, aged  35,  and  mother  32,  at  time  of  H.'s  birth.  Has  a  sister 
and  brother  also  feeble-minded. 

Case  E. — F.  C.  Boy;  13  years  old  when  photograph  was  taken. 
F.  was  such  an  excitable  infant  that  he  was  kept  under  the  influence 
of  opiates  up  to  11  months,  when  he  was  adopted  by  some  benevolent 
people  in  good  circumstances.  When  6  years  old  began  to  give 
trouble ;  was  vicious  and  mischievous,  cruel  to  other  children,  de- 
structive and  brutal,  even  stoning  passers  by — in  fact  became  a  nui- 
sance in  the  neighborhood.  No  discipline  seemed  to  affect  him,  as 
he  was  absolutely  without  fear  of  man  or  beast,  although  a  thun- 
der-storm would  set  him  wild  with  fright.  Apparently  affectionate 
with  his  play-fellows,  yet  at  the  very  moment  of  fondling  them  he 
would  pinch,  scratch,  and,  if  opportunity  offered,  bite  them.  Was 
sent  to  public  and  to  private  schools,  and  his  adopted  mother 
tried  to  teach  him  at  home ;  all  of  no  avail,  he  either  could  not  or 
would  not  learn.  When  8  years  old  he  deliberately  set  fire  to  his 
adopted  father's  warehouse,  which  adjoining  the  dwelling,  both  were 
burned  to  the  ground.  Notwithstanding  he  had  brought  ruin  to 
his  benefactors,  they  were  still  devoted  to  him,  and  would  have  kept 
him  with  them  had  not  the  neighbors  vigorously  protested. 

Came  to  us  at  9  years,  a  tall,  slender,  nice-looking  boy,  with  a 
sweet  face,  fair  skin,  blue  eyes,  and  light  hair;  neat,  clean,  playful, 
and  talkative.  Was  soon  found  to  be  untrustworthy — a  liar,  a  thief, 
with  a  violent  temper  easily  aroused,  a  persistent  run-away ;  in  fact, 
everything  that  was  bad.  His  slovenly,  awkward  gait  was  improved 
by  military  drill,  but  making  little  or  no  progress  in  school,  his  de- 
velopment was  found  in  industrial  work,  in  which  he  became  quite 
useful. 

In  his  sixteenth  year  he  became  so  dangerous  and  violent  that  it 
was  found  necessary  to  remove  him  to  an  insane  hospital,  for  al- 
though not  insane,  he  needed  that  kind  of  restraint. 


270  ILLUSTRATIVE    CASES. 

Case  F. — S.  E.  Boy;  aged  15  years.  Entered  Training  School  at 
9.  Had  a  pleasant  face;  brown  hair  and  eyes;  extremely  ner- 
vous, laughing  and  weeping  without  cause.  Always  backward  in 
school,  but  learned  eventually  to  read  and  write.  Was  an  adroit 
thief,  cruel  to  children,  crafty,  disobedient,  and  self-willed ;  would 
sacrifice  anything  and  anybody  to  get  his  own  way.  No  respecter 
of  persons,  would  attack  anyone.     Absolutely  insensitive  to  pain. 

First-born ;  nourished  by  mother ;  a  sickly  child,  who  suffered 
from  hernia.  During  gestation  the  mother  was  much  distressed  by 
the  death  of  her  mother.  Father,  a  day  laborer,  mentally  below 
par,  was  drunk  at  time  of  conception.  Father  was  24  and  mother 
22,  at  time  of  S.'s  birth.  Father  used  tobacco  inordinately — smoked 
constantly — and  was  drunk  fully  3  days  out  of  7.  Both  father  and 
mother  are  extremely  nervous  and  given  to  hysterical  attacks. 
Paternal  grandfather  and  maternal  grandfather  both  died  of  phthisis, 
as  did  also  a  sister  and  brother  of  the  mother. 

Case  G. — L.  D.  Boy;  16  years  old  when  photograph  was  taken. 
Bright-faced,  good-natured,  well-formed,  very  erect,  when  coming 
to  us  at  9  years  of  age.  In  school  he  could  not  learn  to  read  or 
write.  Very  egotistic,  he  was  much  mortified  at  his  backward- 
ness ;  would  hire  other  boys  to  coach  him,  and  in  time  learned 
to  write  his  own  name,  and  to  spell  a  few  words  only,  although 
every  effort  was  made  and  individual  attention  given  by  most  capa- 
ble teachers.  Meanwhile  his  development  through  the  manual  arts, 
in  a  period  of  9  years,  was  phenomenal.  The  results  of  military, 
physical  and  athletic  exercises  were  noticeable  in  a  fine  physique, 
good  bearing,  excellent  carriage,  and  entire  absence  of  the  dragging 
foot-step  peculiar  to  the  imbecile.  With  a  figure  erect  and  well- 
knit,  he  excelled  in  athletic  sports,  and  was  a  very  graceful  dancer. 
With  powers  of  attention,  imitation,  and  memory,  each  and  all  ex- 
ceptional, he  developed  in  household  service  gifts  which,  had  he 
been  normal,  would  have  placed  him  above  the  ordinary  either  as 
chef,  butler,  or  valet.  In  bakery  and  cooking  class  he  was  a  depend- 
ence for  pastry  and  fancy  desserts ;  in  the  dining-room  he  would 
arrange  and  serve  a  dinner  of  six  courses,  needing  hardly  a  com- 
mand, so  observant  was  he  and  silently  obedient  to  the  slightest  sign. 
If  going  on  a  journey,  I  had  only  to  intimate  for  what  occasion  and 
for  how  long,  and  my  trunk  or  bag  would  be  packed,  not  lacking 
the  smallest  article  of  toilet  detail. 

He  was  a  very  good  tailor — excelling  as  a  presser.  Fond  of 
music,  and  playing  the  baritone  horn  in  the  band,  he  also  developed 
a  fine  baritone  voice,  taking  leading  parts  in  our  light  operas.  Al- 
though unable  to  read,  and  having  to  be  taught  orally  the  words  of 
songs,  he  had  no  difficulty  with  notes,  quickness  of  ear  and  eye  prob- 
ably enabling  him  to  follow  or  to  guess. 


MIDDLE-GRADE    MORAL    IMBECILES.  2J I 

In  free-hand  drawing,  designing,  wood-carving,  and  crayon-work 
he  was  also  successful.  Several  of  his  studies  in  black  and  white 
he  framed,  getting  out  the  mats  and  frames  and  designing  and  burn- 
ing in,  or  carving  the  decorations. 

An  incident  in  connection  with  one  of  these  pictures  shows  the 
peculiarity  of  the  boy  as  well  as  the  intense  egotism  of  the  imbecile. 
It  formed  part  of  an  exhibit  at  a  meeting  of  the  National  Educational 
Association,  where  there  were  some  class  exercises  in  which  he  was 
to  take  part,  each  article  bearing  the  initials  and  grade  of  the  worker. 
When  he  learned  that  his  picture  was  labelled  "  middle-grade  "  he 
managed  to  exchange  the  label  for  one  of  "  high-grade,"  and  on  find- 
ing that  his  correction  had  been  corrected,  he  bribed  a  boy  to  steal  the 
ticket. 

Very  vain  of  his  personal  appearance,  he  improved  every  oppor- 
tunity to  pose  before  a  mirror.  A  waif  from  the  almshouse,  he  in- 
dulged in  delusions  of  grandeur,  and  imagining  that  he  was  descended 
from  noble  people,  would  tell  wonderful  tales  of  the  magnificence  in 
which  his  family  had  lived,  and  managing  to  steal  a  photograph 
of  the  then  Empress  of  Russia,  passed  it  off  as  a  picture  of  his 
mother.  Crafty  and  a  past  master  in  the  art  of  deceiving,  he  would 
slip  from  one  lie  to  another  until  detected,  when  he  would  make  an 
open  confession  in  his  own  frank  way,  weep  a  little  with  extravagant 
protestations  of  penitence  and  promises  of  amendment,  and  would 
immediately  proceed  to  plan  out  another  scheme.  Apparently  affec- 
tionate, loyal  and  disinterested,  he  was  deceitful,  dishonest  and 
thoroughly  calculating,  to  which  was  super-added  all  the  sexual 
vices.  When  22  years  old  his  engaging  manners  attracted  a  gentle- 
man who  felt  that  he  ought  to  make  a  success  out  in  the  world, 
but  ignorance  of  the  3  R's  always  precluded  competition  with 
normal  people,  for  he  could  neither  count  nor  appreciate  the  value 
of  money.  After  repeated  failures  he  was  finally  engaged  as  a 
private  attendant  to  a  wealthy  patient  in  an  insane  hospital.  Here 
he  got  into  trouble  with  a  girl,  stole  from  his  patient  and  was 
quickly  discharged.  Again,  as  in  the  beginning,  a  waif  and  stray, 
more  than  once  he  drifted  back  to  us,  a  pauper,  starving  and  in 
rags,  to  be  fed,  cared  for  and  started  afresh,  only  to  fall  again, 
for,  wholly  irresponsible  and  taking  to  drink,  he  sank  lower  and 
lower. 

Passing  one  evening  a  crowd  of  "  toughs  "  at  a  street  corner,  I 
was  to  my  amazement  respectfully  saluted — a  hand  instinctively 
raised  to  the  cap,  showing  the  military  training — and  there  was  poor 
L.  Shortly  afterwards  he  appealed  to  a  former  comrade,  another  of 
our  boys,  a  respectable  young  carpenter  lodging  in  a  neighboring 
village,  who  took  him  in,  fed  him,  clothed  him,  and  going  off  to  work, 


272  ILLUSTRATIVE    CASES. 

left  him  in  his  room;  returning  he  found  the  fellow  had  decamped, 
taking  with  him  his  small  savings  and  his  Sunday  coat. 

A  tramp  and  a  vagabond,  he  is  now,  much  broken  in  health,  an 
inmate  of  the  almshouse. 

Case  H. — C.  W.  Boy;  aged  15  years  when  photograph  was  taken 
and  12  when  entering  Training  School.  Brown  hair,  gray  eyes,  sight 
and  hearing  good ;  had  engaging  manners,  but  proved  sulky,  brutal, 
cruel,  and  dangerous,  sly,  untruthful,  and  an  adroit  thief.  His  re- 
deeming trait  was  his  fondness  for  animals,  to  which  they  responded, 
his  influence  over  them  being  truly  wonderful.  I  have  seen  him 
handle  with  entire  immunity  from  harm,  a  coon  that  would  bite 
savagely  at  anyone  else;  he  simply  hypnotized  squirrels,  and  con- 
stantly carried  snakes  in  his  pockets;  his  special  favorite,  a  large 
black  snake,  was  over  4  feet  in  length.  Powers  of  attention,  imita- 
tion, and  memory  fair.  Learned  to  read,  write,  and  cipher.  Had  a 
good  tenor  voice  and  played  well  on  the  drum  in  the  band.  Abso- 
lutely fearless,  he  would  do  anything  to  accomplish  a  purpose.  If 
detected  in  wrongdoing  he  would  make  humble  confession  with 
promises  of  amendment  and  would  immediately  proceed  to  carry  out 
his  designs  perhaps  on  other  lines.  A  run-away,  he  had  delusions 
of  persecution  and  gave  much  trouble  generally. 

Under  training  in  shoe-shop  did  very  good  work,  but  as  time  went 
on  became  more  brutal  and  untruthful.  Finally  withdrawn  from  our 
care  by  his  mother  who  had  married  a  second  time  (a  feeble-minded 
man),  the  mother  and  son  within  a  few  days  made  an  attack  upon 
the  husband,  and  beating  and  disabling  him,  literally  threw  him  out 
of  the  house  and  then  walked  round  and  round  him  shouting,  scream- 
ing, crowing  and  flapping  their  arms  like  wings,  for  the  delectation 
of  their  neighbors. 

Later  C.  enlisted,  during  the  Spanish-American  War,  but  his  de- 
fect soon  discovered,  he  was  discharged.  He  is  now  a  tramp, 
wandering  over  the  country,  has  been  in  custody  more  than  once, 
and  will  always  be  a  menace  to  society. 

First-born ;  ordinary  labor ;  nourished  by  mother,  who  was  sub- 
jected to  many  hardships  during  gestation.  The  father  32  and 
mother  30  years  of  age,  at  time  of  C.'s  birth.  The  father,  peculiar 
and  erratic,  making  a  precarious  living  as  a  trapper  and  hunter, 
finally  disappeared.  The  mother,  an  ignorant  pauper,  syphilitic  and 
insane,  was  subject  to  delusions;  thus  she  called  this  boy  the  Duke 
of  Wellington,  and  always  addressed  him  in  the  most  respectful 
terms,  as  she  did  also  his  younger  brother,  who,  his  exact  counterpart 
both  mentally  and  morally,  she  called  Prince  Charles  Edward. 

The  second  child  was  still-born  and  is  said  to  have  resembled  a 
ground  hog;  the  mother  had  sustained  a  severe  fright  during  preg- 


MIDDLE-GRADE    MORAL   IMBECILES.  273 

nancy,  the  father  having  shot  a  ground  hog  and  thrown  it  in  her 
lap.  The  maternal  grandfather  was  insane ;  the  paternal  grandfather 
became  blind  late  in  life ;  both  grandmothers  died  victims  of  ex- 
cessive smoking. 

Case  I. — K.  G.  Boy;  19  years  old  when  photograph  was  taken. 
Tall,  handsome,  of  fine  physique,  with  engaging  manners.  When  he 
came  to  us  at  18  years  of  age,  could  read  and  write  fairly  well,  but 
took  little  interest  in  school  work,  had  a  good  voice  in  singing, 
learned  to  play  on  both  drum  and  cornet,  and  responded  to  military 
and  physical  training.  Did  fairly  good  work  in  shoe-shop.  Tried 
to  do  right  and  always  regretted  when  he  went  wrong,  but  had 
no  moral  anchor.  A  liar,  a  thief,  and  a  mischief-maker,  he  was 
always  in  trouble,  and,  a  veritable  tramp,  simply  could  not  resist  when 
the  "  Wanderlust "  took  possession  of  him.  Ran  away  once,  and 
worked  his  way  on  a  cattle-steamer  to  Antwerp  and  back.  Trying 
for  admission  to  the  U.  S.  Army,  he  was  refused  upon  the  first  in- 
timation that  there  was  even  slight  mental  defect.  Later,  applying 
again  without  explanation,  he  passed  the  examination,  was  enlisted 
and  rendered  very  good  service  during  the  Spanish-American  War, 
the  discipline  proving  just  what  he  needed.  Latest  accounts,  how- 
ever, show  that  he  has  again  taken  to  the  road. 

But  little  is  known  of  family,  except  that  they  were  respectable 
people,  2  brothers  being  Lutheran  ministers. 

Case  J. — J.  M.  Boy;  aged  15  years  when  photograph  was  taken. 
Sturdy,  well-formed,  sight,  hearing  and  speech  normal.  Came  to  us 
when  10  years  old.  A  run-away,  possessed  of  a  most  violent  temper, 
was  untruthful,  deceitful  and  cruel,  and  very  unclean  in  habits. 
Recognized  a  few  letters  and  figures  and  could  count.  Sent  to  school, 
learned  to  drill  and  to  read  a  little,  but  was  so  disorderly  and  dis- 
obedient that  but  little  could  be  done  with  him.  The  slightest  con- 
tradiction or  any  attempt  at  correction  would  throw  him  into  a  rage 
during  which,  absolutely  beside  himself,  he  would  attack  anyone 
within  reach.  Did  very  good  work  in  the  shoe-shop  and  in  dormi- 
tory, but  as  years  went  by,  degenerated  morally.  In  his  fifteenth 
year  he  very  ingeniously  picked  the  locks  of  two  doors  and  escaped. 
When  caught  and  brought  back  his  stockings  were  found  to  be  filled 
with  tobacco,  very  carefully  concealed.  The  following  day  he  broke 
the  wire  from  one  of  the  window-guards,  picked  the  lock  of  the 
door,  and  again  escaped.  Again  brought  back  and  placed  in  the 
"  Quiet,"  the  attendant  on  duty,  hearing  a  scraping  noise  and  going 
to  investigate,  found  that  he  had  cut  the  door ;  how  could  not  be 
discovered  until  after  long  search  a  shoe-knife  was  found,  that  he  had 
stolen  from  the  man  who  had  captured  and  brought  him  back.  Be- 
coming more  and  more  troublesome,  he  was  finally  removed  to  the 
18 


274  ILLUSTRATIVE    CASES. 

almshouse.  Returning  some  months  after  in  a  most  deplorable  con- 
dition, he  in  the  few  hours  that  he  was  here  managed  to  steal  a 
suit  of  clothes  and  run  off  with  them,  and  since  then  has  not  been 
heard  of. 

Nothing  is  known  of  his  family  history. 

Case  K. — H.  F.  Boy ;  aged  about  10  years  when  admitted  to  the 
Institution  and  photograph  was  taken.  Rather  large  head,  gray 
eyes,  pale  complexion,  black  hair,  peculiar  "  grey-hound "  face 
with  pointed  nose.  Was  nervous,  hysterical  and  sensitive  to  ridicule. 
Obstinate,  profane,  sly,  and  untruthful.  Undersized,  sight  and  hear- 
ing acute,  hands  small,  and  quite  deft  with  fingers.  Had  some 
knowledge  of  the  3  R's,  and  did  very  well  for  a  time  in  school,  his 
cleverness  giving  at  first  a  pleasing  impression;  but  this  very  soon 
wore  off. 

Passed  on  from  school  to  school,  and  from  attendant  to  attendant, 
he  bit,  tore,  stole,  fought,  and  tried  the  soul  of  every  man  and  woman 
with  whom  he  came  in  contact.  He  simply  could  not  be  good,  dis- 
ciplining having  no  effect  upon  him. 

With  a  curiosity  as  indefatigable  as  was  his  ingenuity  in  accom- 
plishing a  purpose,  he  was  soon  a  ring-leader  of  mischief  in  the 
school  until  finally  having  reached  his  mental  limit,  he  was  transferred 
to  one  of  the  custodial  buildings,  where  for  a  time  he  proved  an  ex- 
cellent aid  in  housework ;  but  his  inordinate  egotism,  intolerable  un- 
truthfulness, hypocrisy,  and  cruelty  increased  with  time,  and  he  gave 
so  much  trouble  that  it  was  thought  best  to  retire  him  to  a  private 
room — the  "  Quiet."  The  matron,  a  kind-hearted  woman,  in  her 
visits  found  him  within  a  few  days  very  contrite,  declaring  his  inten- 
tion of  being  good,  but  at  the  moment  she  turned  to  leave  him  he 
made  a  savage  attack  upon  her,  seriously  injuring  her  right  arm. 

Dr.  Kerlin  wrote  of  him  when  12  years  old :  "  The  end  of  this  boy 
must  be  only  sorrow  to  himself  and  to  all  who  have  to  do  with  him." 
Two  years  later  he  makes  the  following  entry :  "  H.  has  again  run 
away,  and  the  saddest  thing  about  it  is  that  he  will  come  back  again. 
He  is  so  crafty  and  well  able  to  convince  those  who  have  not  had 
long  experience  with  him  of  his  innocence  of  purpose,  as  to  be  a 
constant  source  of  anxiety,  and  we  can  never  feel  quite  sure  where 
he  is  unless  we  see  him.  He  can  lead  our  better  class  of  boys  which 
way  he  chooses,  and,  unfortunately,  he  never  chooses  the  right  way. 
While  allowed  to  have  the  liberties  of  our  best  boys  and  live  among 
them,  his  example  of  successful  deceit  and  falsehood  is  very  injuri- 
ous. There  is  something  fearful  in  his  cool,  deliberate  plan  to  do 
evil.     If  phthisis  would  develop,  it  would  be  the  happiest  issue." 

H.  was  removed  from  the  Institution  in  his  fifteenth  year,  and 
drifting   from   place  to    place,   he   was   convicted   of   larceny,   im- 


HIGH-GRADE    MORAL   IMBECILES.  275 

prisoned,  and  finally  sent  to  an  insane  hospital,  where  he  ex- 
hausted the  patience  of  all  with  whom  he  came  in  contact,  formu- 
lating the  most  disgusting  methods  of  revenge  upon  any  whom  he 
disliked. 

In  his  seventeenth  year,  exhibited  by  a  specialist  before  a  class  as 
a  moral  imbecile,  he  was  delighted  at  the  sensation  he  created.  Nine 
years  later  he  suddenly  appeared  at  the  Institution,  in  a  half-starved 
condition,  his  face  marred  with  the  traces  of  crime  and  his  hair  en- 
tirely gray.  Fearing  to  retain  him,  he  was  fed,  clothed  and  sent  off. 
The  few  of  his  former  friends  whom  he  was  permitted  to  see,  he 
advised  to  remain  where  they  were,  as  it  was  very  hard  to  get  along 
out  in  the  world.  Although  expressing  penitence  for  the  past,  his 
egotism  yet  induced  him  to  relate  to  the  attendants  with  great  pride 
and  bombast  his  various  adventures,  many  doubtless  being  figments 
of  fancy. 

A  year  later  the  press  was  filled  with  accounts  of  a  shocking  mur- 
der committed  in  another  state,  the  perpetrators  skillfully  eluding 
detection.  H.  seeing  the  opportunity  to  create  a  sensation,  reported 
to  the  authorities  that  while  in  a  certain  jail  for  some  petty  offence 
he  had  overheard  two  men,  whose  names  he  gave,  discussing  in  an 
adjoining  cell  the  details  of  this  crime,  which  they  had  committed. 
The  story  investigated,  proved  absolutely  without  foundation. 
Neither  he  nor  the  men  he  described  had  ever  been  in  the  prison  he 
named.    Since  then  nothing  has  been  heard  of  him. 

The  seventh  child  born;  a  7  months'  gestation;  normal  labor, 
lasting  but  half  an  hour.  Was  fed  artificially  on  goat's  milk,  but 
was  a  weak  and  sickly  child.  Had  a  convulsion  three  days  after  birth, 
and  all  his  life  was  troubled  with  insomnia.  Did  not  walk  until 
second  year. 

The  mother,  a  strong,  healthy  Irish  woman,  but  somewhat  hys- 
terical, was  32,  and  father,  an  American,  36  years  old,  at  time  of  H.'s 
birth.  The  paternal  grandfather  was  a  drunkard  as  was  the  father, 
but  the  latter  claims  to  have  been  temperate  for  a  year  before  and 
after  H.'s  birth.  H.  has  6  sisters — 1  feeble-minded — 1  brother  living, 
and  1  born  dead. 

High-Grade  Moral  Imbeciles  :   trainable  in  manual  and 
intellectual  arts,  with  genius  for  evil. 

Case  A. — L.  G.  Boy ;  aged  15  years  when  photograph  was  taken, 
and  11  years  old  when  entering  the  Training  School.  A  sweet  pa- 
thetic face,  and  engaging  manners.  Articulation  and  vocabulary 
good;  could  read,  write,  and  cipher.  Within  a  few  days  after  ad- 
mission ran  away  to  witness  a  parade  in  Philadelphia,  and  upon 


276  ILLUSTRATIVE    CASES. 

being  brought  back  wept  bitterly  at  the  thought  of  his  father  know- 
ing of  his  misdemeanor.  His  parents  are  religious,  respectable  Ger- 
mans ;  the  father  a  superintendent  of  a  mill. 

At  12  years  of  age,  tiring  of  school  routine,  was  allowed  to  work 
with  gardener  part  of  the  day  and  to  enter  the  music  class.  Learned 
cornet  very  quickly,  but  his  teacher  makes  the  following  record  of 
him :  "  He  is  quick  to  understand  but  there  is  an  undertone  of  deceit 
in  his  character.  He  is  not  as  open  and  straightforward  as  I  would 
like  to  have  him." 

A  few  months  later  on  account  of  bad  behavior  was  removed  from 
school  entirely,  and  put  to  work  out  of  doors.  His  father  then  de- 
termined to  give  him  a  trial  at  home,  but  there  he  proved  so  lawless 
and  unmanageable  that  his  parents  begged  for  his  return.  They 
report  L.  as  simply  unbearable;  disobedient,  quarrelsome  with  his 
brothers  and  sisters,  and  the  boys  in  the  neighborhood,  and  brutal 
and  disrespectful  to  parents.  Indulged  in  screaming  spells,  and 
vile  and  profane  language.  Refused  absolutely  to  return  to  the 
Institution,  and  was  brought  back  by  a  policeman.  Here  defiant, 
vulgar,  dishonest,  sly,  deceitful,  dissatisfied,  he  lost  interest  even  in 
his  music  and  accomplished  nothing  in  school.  Ran  away  persis- 
tently and  no  disciplining  seemed  to  affect  him  in  this  particular. 
At  times  he  could  be  very  attractive,  and  his  innocent  face  was 
most  misleading.  After  some  months,  responding  to  the  influence 
of  a  teacher,  he  paid  more  attention  to  his  music,  and  was  generally 
more  orderly,  improving  mentally,  and  growing  more  quiet.  He 
never  laughed,  rarely  smiled ;  sat  much  apart  from  the  others,  look- 
ing into  space,  apparently  dreaming.  There  were  reports  of  cruelty 
towards  smaller  boys  from  time  to  time,  but  no  proofs ;  and  he  took 
care  that  there  should  be  none.  A  change  of  teachers  in  his  six- 
teenth year  brought  new  developments  and  his  true  nature  again 
asserted  itself.  His  new  music  teacher  makes  the  following  note : 
"  I  do  not  know  what  to  say  about  L.  I  cannot  understand  him ; 
he  seems  such  a  mixture  of  good  and  bad.  Plays  very  well  on  the 
cornet,  but  is  noisy  and  disobedient." 

From  this  time  on,  there  was  marked  mental  improvement  coupled 
with  moral  deterioration  equally  marked.  In  music,  in  military  ex- 
ercises, and  in  manual  work  he  advanced.  Learned  a  trade  and 
really  did  excellent  work  in  both  tailor  and  carpenter  shop ;  but 
absolutely  unreliable  and  undependable,  he  grew  daily  more  treach- 
erous, brutal,  and  cruel,  openly  terrorizing  the  smaller  boys.  Rea- 
soned with  and  disciplined,  he  hardened  under  kindness  and  became 
restless  under  restraint.  Both  punishments  and  rewards  were  tried 
with  negative  results.  An  egoist,  absorbed  in  dreams,  his  one  am- 
bition was  to  win  a  name  as  a  professional  prize-fighter ;  his  one 


HIGH-GRADE    MORAL   IMBECILES.  277 

delight  was  posing  before  a  mirror  stripped  to  his  waist  in  the  atti- 
tude of  Corbett,  who  was  his  beau  ideal. 

Constantly  plotting  mischief,  and  usually  clever  enough  to  cover 
his  tracks  for  the  time,  he  organized  a  plot  to  attack  an  attendant 
to  whom  he  had  taken  a  violent  dislike.  Dominating  his  club  he 
made  the  lives  of  many  boys  miserable,  and  punished  severely  boys, 
as  large  as  himself,  who  refused  to  obey  him ;  would  use  the  most 
violent  language  towards  them  and  would  even  spit  in  their  plates. 
During  the  last  years  of  his  school  life,  homicidal  impulses  devel- 
oped strongly,  and  his  career  in  the  Institution  culminated  in  a  brutal 
attack  upon  a  boy  whom  he  one  evening  waylaid,  and  without  provo- 
cation, knocked  down,  and  holding  his  head  between  his  knees,  spat 
in  his  face,  choked  him,  rained  blows  upon  head  and  face,  and  at- 
tempted to  gag  him.  Immediately  after,  he  wrote  letters  of  apology 
to  both  the  boy  and  myself,  and  then  ran  away. 

After  fruitless  endeavors  to  obtain  work,  he  returned  home,  but 
as  before  his  presence  there  proved  intolerable,  and  the  safety  of  his 
family  demanded  his  commitment  to  an  insane  hospital.  There  un- 
der stricter  discipline  he  did  excellent  work  for  5  years,  until  with 
his  usual  cleverness,  he  managed  to  escape.  A  few  days  later,  meet- 
ing him  on  the  street,  he  greeted  me  most  effusively,  telling  me  that 
he  had  secured  an  engagement  in  the  city.  Fairly  well  clad,  but  dirty 
and  unshaven,  his  childish  beauty  and  engaging  manners  had  given 
place  to  an  expression  of  brutality,  and  a  coarseness  of  demeanor. 

The  next  day  I  received  the  following  letter  from  him : 

"  My  friend  Dr.  Barr:  I  was  real  pleased  to  see  you  in  a  way,  and 
sorry,  because  I  felt  ashamed  of  myself.  I  send  my  apology  for 
telling  you  a  falsehood,  but  the  circumstances  that  im  in  I  felt  that 
I  had  to.  To  tell  the  truth,  I  ran  away  from  the  Insane  Hospital 
about  a  week  ago.  I'm  not  stopping  at  home.  Iv  got  to  hunt  my 
bed  up,  when  night  draws  on,  the  way  I  do  I  walk  out  in  the  coun- 
try, rather  than  go  to  these  bug  houses  where  these  tramps  go.  Last 
night  I  was  walking  along  Willow  St.  to  catch  a  freight  I  was  at- 
tacked by  three  bums,  well  I  fixed  two  of  them,  the  other  one  ran 
for  dear  life.  Then,  when  it  was  all  over,  the  man  in  blue  came 
along,  but  I  said  nothing  and  walked  as  fast  as  I  could.  I  wish  I 
was  a  detictive.  I  could  hunt  up  many  a  clue.  I  often  feel  sorry 
that  I  left  Elwyn.  Will  you  please  take  me  back  again  or  give  me 
a  job.  I  would  be  of  big  help  to  you  in  the  band.  Theres  one  thing 
I  have  a  good  report  at  the  Hospital.     Please  answer. 

"  Your  friend, 

"L.  G." 


278  ILLUSTRATIVE    CASES. 

Case  B. — L.  K.  Girl ;  aged  14  years  when  photograph  was  taken. 
Came  to  the  Training  School  in  her  sixth  year.  An  attractive  child 
with  blue  eyes  and  yellow  hair.  Willful  and  obstinate  at  first,  but 
soon  responded  to  influence.  Quick  to  imitate;  did  well  in  kinder- 
garten, and  later  in  school  learned  to  read  and  write,  to  sew  and  em- 
broider, but  began  to  deteriorate  morally  and  after  her  eighth  year 
never  ceased  to  give  trouble.  Using  her  acquirements  for  evil  pur- 
poses, she  was,  at  16,  a  thief,  a  liar,  and  a  nymphomaniac  who  could 
not  be  trusted  alone,  and  would  pass  notes  to  boys  in  the  most 
ingenious  fashion.  An  expert  in  thieving,  she  could  lie  with  the 
most  unblushing  effrontery  and  apparent  innocence.  Could  be  clean 
in  speech  and  circumspect  in  conduct,  but  at  times  in  both  language 
and  action  was  most  vile.  Had  wonderful  influence  over  girls  of 
lower  grade  and  used  them  as  tools. 

In  her  twenty-fifth  year,  having  grown  to  be  an  attractive  and 
even  handsome  young  woman,  she  was  yet  so  unmanageable  that 
she  was  transferred  to  an  insane  hospital.  From  there,  through  the 
ill-advised  efforts  of  some  sentimental  philanthropists,  she  was  re- 
leased with  the  idea  that  she  was  capable  of  self-support. 

Since  then  she  has  drifted  naturally  downwards,  and  having  given 
birth  to  an  illegitimate  child,  is  now  in  the  syphilitic  wards  of  a 
charity  hospital. 

Father,  a  blacksmith,  41  years,  and  mother,  an  imbecile  domestic, 
30  years  of  age,  at  time  of  child's  birth.  Father  brutal,  abused  and 
beat  mother,  who,  a  victim  also  of  overwork,  suffered  intense  pain 
two  weeks  prior  to  child's  birth.  Labor  long  and  difficult.  Both 
parents  drunkards,  as  were  also  both  grandfathers.  Maternal 
grandfather  had  an  imbecile  sister. 

Case  C. — M.  W.  Boy ;  9  years  old  when  photograph  was  taken ; 
5  when  entering  Training  School.  Bright  face,  with  dark  eyes  and 
hair,  and  sharp  features.  Wild,  passionate,  profane,  undisciplined 
generally,  and  fighting  continually.  Enunciation  slightly  defective. 
Placed  in  kindergarten,  made  but  slight  improvement  in  behavior, 
but  advanced  rapidly  in  hand  work. 

As  time  went  on,  learned  to  care  for  himself  and  to  read  and 
write,  but,  growing  daily  more  vulgar,  profane,  dishonest  and  un- 
ruly, would  attack  even  his  teacher.  A  persistent  run-away,  he 
seized  every  opportunity  to  escape.  Developed  the  habit  of  spitting 
upon  and  biting  little  children,  and  kicking  them  in  the  face  and 
stomach.  His  teacher  makes  note  of  him  in  his  thirteenth  year: 
"  I  wish  I  could  say  something  good  of  M.  but  I  cannot,  for  he  is 
wicked  in  every  way  and  gives  constant  trouble."  Could  be  very 
engaging,  but  it  was  usually  when  he  was  plotting  mischief. 

In  his  seventeenth  year  he  escaped  to  carry  trouble  elsewhere,  for 


Plate  XLVII 


Case  E. 
INSANITY. 


HIGH-GRADE    MORAL   IMBECILES.  279 

wherever  he  is,  there  evil  will  follow.  I  have  heard  of  him  once 
since.  Arrested  under  an  assumed  name  for  some  offence,  he  re- 
ferred to  me  for  a  character. 

Of  his  mother,  apparently  a  respectable  woman,  it  was  discovered 
later,  that  this  boy  was  the  child  of  her  own  father. 

Case  D. — L.  W.  Boy ;  aged  10  years  when  photograph  was  taken ; 
8  when  he  came  to  the  Training  School,  but  small  for  his  age,  was 
still  wearing  dresses.  Red  hair  and  blue  eyes.  Talked  slowly,  but 
had  good  vocabulary.  Absolutely  undisciplined  and  difficult  to  man- 
age, his  one  cry  was  "  I  won't,  I  won't."  Could  be  a  delightful  child, 
but  more  often  was  so  naughty  that  he  exhausted  everyone's  patience. 
Hot-tempered,  defiant  and  obstinate,  neither  coaxing  nor  discipline 
had  the  slightest  effect  upon  him. 

Passed  rapidly  through  the  kindergarten  into  the  schools  where 
he  did  well  in  geography,  history,  and  language,  in  military  and 
physical  exercises  and  dancing.  Learned  to  draw  and  to  play  on 
the  cornet  and  piccolo ;  was  in  fact  one  of  our  brightest  boys,  but  his 
insolence  and  violence  grew  in  proportion.  A  disturbing  element  in 
the  schools,  fertile  in  expedients  for  annoying  both  teachers 
and  pupils,  his  vindictiveness  was  marked.  For  instance  a  boy 
who  had  inadvertently  offended  him  had  a  picture  he  valued,  and  L. 
requesting  to  look  at  it,  immediately  tore  it  in  pieces.  Developed  a 
fondness  for  animals  and  insects,  especially  for  butterflies,  but  was 
intensely  cruel  to  children.  Everywhere  troublesome,  needing  watch- 
ful supervision,  he  yet  became  quite  efficient  in  household  service 
and  also  in  the  printing  office.  Left  the  Institution  in  his  seventeenth 
year  and  found  employment  in  a  mill.  While  a  good  worker,  he  is 
constantly  in  trouble,  a  fomenter  of  mischief,  and  his  countenance 
now  betokens  increased  hardness  and  brutality. 

Third  child ;  born  at  7  months ;  nourished  by  mother.  Father 
a  druggist  and  insane.     Maternal  grandparents  both  died  of  phthisis. 

Case  E. — J.  L.  Boy ;  aged  14  years  when  photograph  was  taken. 
Came  to  my  notice  when  he  was  12  years  old.  A  child  of  attractive 
personality  and  engaging  manners,  yet  seemed  absolutely  destitute 
of  natural  affection.  When  5  years  old  he  found  a  pistol  under  his 
father's  pillow,  and  shot  his  sister  in  the  face.  The  little  girl  re- 
covered, but  with  slight  hemiplegia,  and  it  is  thought  that  the  inci- 
dent had  a  bad  effect  upon  the  boy,  who  was  much  excited  at  the 
time. 

He  could  read  and  write  and  distinguish  color  and  form.  Was 
musical,  developed  an  excellent  voice  and  did  fairly  good  work  with 
the  cornet  and  drums.  An  egoist,  he  was  fond  of  attracting  atten- 
tion and  praise,  and  would  do  all  manner  of  nice  things  to  win  them. 
In  school,  was  ready  and  clever  in  recitation,  but  impertinent  to 


28o  ILLUSTRATIVE    CASES. 

teachers,  self-willed  and  disliking  correction,  was  a  bully  where  he 
dared  be.  Much  given  to  bombast  and  braggadocio,  dishonest, 
brutal,  malicious  and  untruthful,  he  was  thoroughly  disliked  even 
by  those  boys  to  whom  he  was  generously  disposed. 

In  his  sixteenth  year  was  put  in  the  shoe-shop  where  he  might  have 
done  excellent  work  but  for  his  unconquerable  indolence.  Becoming 
more  rebellious,  troublesome,  and  disorderly,  his  attacks  of  temper 
were  ungovernable. 

Going  out  into  the  world  in  his  seventeenth  year,  he  wrote  many 
letters  from  various  places,  giving  always  glowing  descriptions  of 
himself  and  his  adventures.  Within  a  year  he  presented  himself  at 
Elwyn  to  solicit  our  patronage,  pretending  to  have  learned  the  trade 
of  repairing  musical  instruments.  Later  joining  a  theatrical  com- 
pany, he  got  into  some  trouble,  was  in  jail  and  wrote,  begging  me  to 
bail  him  out. 

First-born  at  full  term;  labor  difficult,  head  being  very  large; 
nourished  by  mother.  Father  30,  mother  22,  years  old,  at  time  of 
his  birth.    Later  mother  was  deserted  by  the  husband. 

Case  F. — R.  B.  Boy;  aged  19  years  when  photograph  was  taken. 
Tall,  slight,  dark,  choreic  and  languid.  With  manners  deferential 
and  cringing  toward  superiors,  he  was  habitually  domineering  and 
disagreeable  to  all  others.  Perfectly  conversant  with  the  proprieties 
of  life,  he  was  yet  addicted  to  many  filthy  habits,  and  would  even 
spit  in  boys'  plates  at  the  table.  Would  refuse  food,  but  at  the  same 
time  would  steal  fruit  or  meat  from  the  dish.  With  an  abundance 
of  fine  clothing  and  supplied  with  every  toilet  luxury,  he  yet  loved 
to  crawl  away  in  dark  corners,  even  into  coal-bins,  to  lie  in  dirt  and 
filth. 

At  school  learned  to  read,  write,  and  cipher,  and  was  greatly  bene- 
fited by  the  military  drill  which  he  cordially  disliked.  Was  disobedi- 
ent, willful,  and  insolent.  Had  a  violent  temper  and  once  made  a 
homicidal  attack  with  a  scythe  on  a  man.  On  one  occasion  was  found 
bombarding  with  rocks  a  house,  in  which  he  had  securely  confined  a 
female  attendant. 

The  father,  a  member  of  the  wealthier  class,  was  willing  to  expend 
any  amount  for  his  comfort  and  improvement,  and  his  step-mother, 
who  lavished  much  affection  upon  the  boy,  was  repaid  only  by  abuse. 
Removed  in  his  twenty-first  year,  and  found  intolerable  at  home,  he 
was  placed  in  the  convalescent  wards  of  an  insane  hospital. 

Case  G. — S.  J.  Boy;  aged  15  years  when  photograph  was  taken; 
12  when  entered  the  Training  School.  A  tall  boy  with  pleasant  ex- 
pression and  nice  manners.  Brown  hair  and  eyes,  and  speech  perfect. 
Could  read,  write,  sing,  and  do  simple  hand-work.  Did  well  in  mili- 
tary drill,  and  in  the  band  with  a  cornet.     After  leaving  school  did 


HIGH-GRADE    MORAL   IMBECILES.  28 1 

fairly  well  as  a  house-painter,  but  slow,  took  2  or  3  days  to  do  what 
an  ordinary  man  would  do  in  one. 

Reached  his  mental  limit  in  sixteenth  year  and  began  to  deteriorate, 
becoming  erratic  and  peculiar.  Became  an  adroit  thief,  an  uncon- 
scionable liar,  and  vulgar  and  obscene  to  a  degree ;  was  constantly 
exposing  his  person.    Could  not  be  trusted  anywhere  near  a  female. 

When  22  years  old  was  removed  by  relatives.  Giving  trouble  at 
home,  was  incarcerated  in  an  insane  hospital.  Released  on  probation, 
his  indecencies  demanded  his  return. 

First-born,  at  full  term ;  ordinary  labor ;  nourished  by  mother, 
an  imbecile,  who  in  her  sixteenth  year  was  the  victim  of  seduction, 
party  unknown.  Was  treated  cruelly  by  family  during  pregnancy. 
Maternal  grandmother  and  grandfather  both  died  of  phthisis. 
Mother  was,  for  a  time,  in  an  insane  hospital. 

Case  H. — F.  H.  Boy;  aged  13  years.  Light  hair,  blue  eyes;  ex- 
pression sly  and  stealthy,  although  changing  like  a  mask,  at  times  to 
one  of  innocent  intelligence.  Speech,  sight,  and  hearing  perfect.  Is 
a  tobacco  fiend,  fond  of  opium  and  of  strong  drink.  A  liar,  a  thief, 
malicious,  cruel  and  destructive ;  dangerous  with  fire.  Is  a  wonderful 
expert  at  picking  locks.  Discovered  a  method  of  opening  a  six-lever 
padlock,  with  six  pins. 

Was  in  jail  3  three  times  before  his  eleventh  year,  for  thieving  and 
malicious  mischief;  is  careful  to  conceal  this  part  of  his  history. 
Powers  of  attention  and  imitation  excellent.  He  is  good  at  domestic 
service  and  very  deft  with  his  fingers.  Has  learned  to  cane  chairs, 
.and  to  knit  hoods,  caps,  and  shawls,  in  a  variety  of  beautiful  and 
intricate  patterns.  Can  read  and  write  a  little  but  as  he  already  uses 
every  mental  acquirement  only  for  evil,  no  effort  has  been  made  to 
equip  him  further  in  that  direction.  When  out  in  the  world,  was  the 
victim  of  the  vicious,  and  could  be  tricked  into  anything.  A  dan- 
gerous character,  a  menace  to  society,  he  should  always  be  kept 
under  close  custodial  care. 

Father,  an  habitual  drunkard,  insane  and  syphilitic ;  cast  off  by 
his  family,  was  55,  and  mother,  who  was  subjected  to  ill-treatment 
during  pregnancy,  15  at  time  of  birth  of  child,  who  was  illegitimate. 


CHAPTER   XVII. 

illustrative  cases  (continued). 

Backward  Children  ;  Imbeciles  by  Deprivation  ;  Negroid  Type  ; 
American  Indian  Type;  Mongolian  Type. 

Backward  Children  :   mental  processes  normal  but  slow  and 
requiring  special  training  to  prevent  deterioration,  etc. 

Case  A. — M.  B.  Male ;  24  years  old  when  photograph  was  taken. 
Nothing  is  known  of  family  nor  of  previous  history,  except  that  he 
was  the  ward  of  a  benevolent  society,  and  could  not  get  on  in  a 
school  for  normal  children.  Coming  to  us  when  10  years  old,  was 
a  strong,  sturdy  little  fellow  with  blue  eyes,  and  a  shock  of  beautiful 
dark-red  hair.  Was  bright  and  active,  recognized  ordinary  colors 
and  forms.  Knew  multiplication  table,  could  read  and  write,  sew 
and  knit,  and  ask  intelligent  questions.  Mischievous  and  good- 
natured,  with  fits  of  sullenness.  Did  exceedingly  well  in  school; 
was  particularly  fond  of  drawing  animals  and  flowers;  but  outside 
was  the  usual  naughty  boy.  When  12  years  old,  was  tried  in  the 
drum  corps  and  did  very  well.  Made  continued  progress,  espe- 
cially in  drawing  and  modelling,  but  was  sulky,  self-willed,  and  dis- 
agreeable ;  fond  of  saying  smart  things  to  make  others  laugh,  inter- 
rupting routine  and  needing  constant  employment  to  keep  him  out 
of  mischief. 

In  his  fourteenth  year  was  given  a  cornet  on  which  he  learned 
to  play  delightfully,  the  tones  he  made  being  peculiarly  clear  and 
liquid ;  he  developed  a  true,  rich  baritone  voice ;  played  exceedingly 
well  on  the  saxophone,  and  was  oblivious  to  everything  else  during 
his  hours  of  practice.  Devoted  to  music,  its  refining  influence  upon 
him  has  been  very  perceptible  from  the  inception  of  his  musical  stud- 
ies. There  began  at  this  time  to  be  a  decided  change  in  his  disposi- 
tion ;  he  grew  more  manly,  trustworthy,  courteous,  and  considerate  of 
others,  and  consequently  popular  with  all.  Much  interested  in  mili- 
tary and  physical  exercises  and  a  splendid  athlete,  he  was  also  an 
omnivorous  reader,  remembering  all  that  he  read.  When  17  entered 
the  bakery  and  did  excellent  work  there  and  also  in  the  carpenter 
shop,  where  he  was  very  handy  with  tools. 

In  his  nineteenth  year  his  record  reads : 

282 


Plate  XLVIII. 


BACKWARD    CHILDREN.  283 

"  From  a  naughty,  troublesome  boy,  S.  has  developed  into  a 
thoroughly  manly  fellow.  Is  polite,  respectful,  and  well  mannered. 
He  is  now  an  excellent  barber,  shaving  over  200  boys  each  week, 
and  keeping  the  heads  of  some  350  in  order." 

Wishing  to  try  his  fortune  in  the  world,  he  was  sent  out  well 
equipped,  and  was  gone  for  6  months,  but  found  it  hard  to  compete 
with  the  rush  and  drive ;  and  missing  the  companionship,  the  amuse- 
ments, the  protection  and  the  refined  environment  of  community  life, 
he  came  back  in  charge  of  his  own  club  of  boys.  He  knew  "  their 
tricks  and  their  manners  "  handed  down  through  generations,  as  they 
are  in  all  schools,  and  understanding  them,  keeps  excellent  order  and 
has  proved  a  valuable  attendant. 

Case  B. — C.  U.  Male;  aged  21  years  when  photograph  was 
taken.  Came  to  us  when  10  years  old.  Had  a  large  globular  head, 
immobile  features,  "  pug  "  nose,  a  large  jaw,  and  "  flopping  "  ears. 
Light  hair,  and  dark  eyes,  slight  ptosis  being  evident.  Carriage 
very  bad.  Unable  to  wash  or  dress  without  supervision.  Table 
manners  faulty,  preferring  to  eat  with  fingers  and  spoon.  Powers 
of  attention,  imitation,  and  memory  undeveloped.  Talkative,  rest- 
less, and  disobedient. 

In  school  progressed  slowly  and  gradually  learned  to  read  and 
write.  Attained  proficiency  in  military  drill,  and  was  devoted  to 
athletic  sports.  Entered  the  band  and  did  excellent  work  with  the 
cornet.  From  his  twelfth  year  a  marked  improvement  in  every  par- 
ticular was  noted.  He  became  studious,  painstaking,  courteous,  and 
attractive;  with  an  unconscious  working  towards  a  high  standard 
he  aimed  to  do  nothing  unworthy  of  a  gentleman.  While  friendly 
with  all  his  companions,  and  immensely  admired  by  them,  he  was 
intimate  with  none.  Made  rapid  progress  in  all  the  common  school 
branches,  and  in  the  hand  crafts.  Was  excellent  in  carpentry,  and 
in  the  printing-office  learned  the  trade  thoroughly. 

In  his  eighteenth  year  he  left  to  accept  a  most  desirable  position 
— one  for  which  he  was  peculiarly  adapted — and  giving  entire  satis- 
faction, he  has  been  rapidly  advanced;  has  travelled  much,  and 
used  his  eyes  to  good  advantage.  To-day  he  is  a  young  man  of 
absolutely  correct  habits,  one  of  whom  any  father  might  be  proud — 
who  reads  a  good  deal — good  literature — and  remembers  what  he 
reads,  and  has  kept  to  his  motto,  "  Friendship  towards  all  and  en- 
tangling alliances  with  none." 

But  little  is  known  of  family  history  except  that  mother,  becom- 
ing insane,  drowned  herself  and  two  children,  C.  escaping  into  a 
corn-field.  Seeming  to  brood  over  this  tragedy,  he  was  considered 
a  stupid  boy  in  the  orphanage  to  which  he  was  taken. 

A  slow  and  backward  child,  he  was  fortunate  in  receiving  early 


284  ILLUSTRATIVE    CASES. 

that  training  suited  to  his  needs,  as  either  neglect  or  overpressure 
would  have  undoubtedly  resulted  in  mental  defect. 

Case  C. — M.  B.  Boy ;  aged  16  years  when  photograph  was 
taken ;  came  to  Training  School  when  10  years  old.  A  pretty  boy, 
whose  rosy  cheeks,  blue  eyes,  light  hair,  and  winning  ways  made 
him  a  favorite  with  all.  Articulation  distinct  and  voice  low  and 
musical.  Wrote  fairly  well,  read  in  second  reader,  and  had  mas- 
tered the  first  four  rules  of  arithmetic.  Could  distinguish  colors, 
and  draw  readily  various  lines,  angles  and  simple  geometric  forms. 
Was  slow  of  comprehension — it  was  difficult  for  him  to  understand — 
but  once  he  apprehended  a  subject  it  was  his  thenceforward.  Was 
deft  in  use  of  hands  and  began  at  once  simple  manual  work. 
Obedient  and  attentive  with  an  excellent  memory,  was  a  trust- 
worthy and  capable  errand  boy.  Manly  and  fond  of  active  sports. 
I  was  treating  him  one  day  for  a  sprained  ankle,  the  result  of  a  fall 
from  a  cherry  tree.  As  I  bandaged  it,  the  tears  rained  down  his 
face,  and  when  I  asked,  "  Does  it  hurt  ?  "  he  replied,  "  Yes ;  but  I 
don't  mind  that ;  I'm  not  a  baby ;  but  I  can't  go  to  the  circus  to-mor- 
row, and  that  does  hurt." 

At  11  years  began  the  study  of  music.  Was  given  an  alto  horn 
on  trial.  In  a  week  learned  the  staff  notes  and  could  make  all  the 
tones  of  the  scale  clearly  from  low  "  C  "  to  upper  "  D."  Within 
4  months  he  had  learned  perfectly  6  simple  airs,  and  within 
eight  months  from  the  time  he  began,  he  was  playing  the  "  solo 
alto,"  and  had  developed  a  fine  tenor  voice.    His  record  reads  thus : 

"  He  is  intelligent,  ambitious,  persevering,  and  makes  excellent 
use  of  his  thinking  powers." 

At  12,  promoted  to  the  highest  grade,  became  more  and  more 
interested  in  his  studies ;  learned  to  draw  admirably,  became  fond 
of  reading  and  was  able  to  discuss  intelligibly  what  he  read.  Con- 
tinued to  make  progress  in  his  music,  and  played  finely  on  the 
cornet. 

At  16  he  was  one  of  our  best  boys;  a  good  influence  in  the 
school — fearless,  gentle,  appreciative  and  sincere,  always  ready 
to  confess  any  little  dereliction  of  duty.  Devoted  to  athletic  sports, 
in  which  he  excelled,  he  developed  physically  and,  interested  in  military 
drill,  was  one  of  the  officers  of  the  company.  A  leader  in  theatri- 
cals, was  a  good  actor.  Devoting  a  portion  of  his  time  to  manual 
training,  he  did  very  good  work  in  carpentry.  Was  neat  and  ex- 
act, although  lacking  originality  and  "  planning  capacity." 

At  18  he  had  completed  the  school  course,  and  in  order  to 
prepare  him  to  take  charge  of  a  class  in  wood-work,  he  was  entered 
at  a  Manual  Training  School  in  Philadelphia.  Here  while  advanc- 
ing steadily  in  mathematics,  wood  and  iron  working,  he  continued 


BACKWARD    CHILDREN.  285 

his  music  practice,  rendering  with  expression  the  compositions  of 
Wagner,  Donazitti,  Verdi,  Balfe,  etc.,  leading,  on  occasion,  the 
entire  band  of  twenty  pieces.  In  vacations  he  gained  an  additional 
experience  in  charge  of  a  group  of  small  boys,  and  would  have  more 
than  equalled  our  expectations,  when  in  his  twentieth  year,  on  the 
eve  of  leaving  school,  he  broke  down  with  phthisis. 

Father  a  blacksmith,  an  epileptic  from  his  eighth  year,  became 
insane  and  was  incarcerated  in  an  insane  hospital  for  seven  years 
before  his  death.  The  mother,  of  very  ordinary  stock,  barely 
reached  the  normal.  Maternal  grandmother  had  softening  of  the 
brain  and  paternal  grandmother  died  insane. 

The  boy  when  two  and  a  half  years  old  was  kicked  in  the  face  by 
a  horse,  and  the  wound,  three  inches  long,  was  twice  sewed  up.  In 
infancy  and  early  childhood  was  much  neglected,  and  from  seventh 
to  tenth  years  was  "  bound  out  " ;  did  rough  work  on  a  farm  from 
which  he  persistently  ran  away.  Finally,  deemed  mentally  defective, 
he  was  brought  to  us. 

Case  D. — M.  H.  Boy ;  1 1  years  old  when  photograph  was  taken. 
Clear  complexion,  brown  eyes  and  hair,  bright  expression.  Entered 
Training  School  in  eighth  year,  exceedingly  dull  and  slow  at  first, 
was  gradually  promoted  from  kindergarten  to  school  where,  although 
the  youngest,  he  always  stood  at  the  head  of  his  spelling  class,  wrote 
a  well-expressed  childish  letter,  and  at  12  years  compared  favorably 
with  any  normal  child  of  10.  At  14,  had  mastered  the  3  R.'s,  so 
far  as  excellent  language  lessons  and  the  four  primary  rules  of  arith- 
metic ;  entered  band,  playing  on  cornet,  taking  first  steps  in  music 
rapidly  and  intelligently.  Prompt  and  obedient  in  military  drill,  he 
was  also  efficient  in  manual  work,  in  household  service,  tailoring,  and 
shoe-making.  Withdrawn  at  the  age  of  18,  he  is  recorded  as :  "A 
loss  to  the  school  of  a  healthful  wholesome  influence."  Is  now,  at 
age  of  26,  a  member  of  a  military  band,  and  doing  well. 

Case  E. — A.  H.  Boy ;  aged  9  years  when  photograph  was  taken ; 
entered  Training  School  in  sixth  year.  Brother  to  the  foregoing 
and  of  the  same  mental  capacity,  he  was  like  him  very  slow  in  com- 
prehending, but  improvement  was  constant  in  school.  Doing  well 
in  music  and  military  drill,  acquired  an  easy  graceful  carriage.  De- 
veloped habits  of  neatness  and  order,  promptness  and  accuracy. 
Had  training  in  household  service,  in  shoe-making  and  tailoring.  Is 
now,  at  24  years  of  age,  earning  a  respectable  living. 

But  little  is  known  of  the  family  history  of  these  two  cases,  ex- 
cept that  the  mother  was  erratic  and  peculiar,  and  that  both  boys 
were  neglected  in  infancy  and  early  childhood.  Fortunate  in  a 
training,  adapted  to  needs  and  free  from  excitement  of  competition 
and  over-pressure,  they  escaped  that  deterioration  leading  inevitably 
to  defect. 


286  ILLUSTRATIVE    CASES. 

Case  F. — S.  M.  Boy;  aged  10  years  when  photograph  was  taken. 
Coming  to  us  in  his  ninth  year,  a  child  small  for  his  age,  with 
dark  hair  and  blue  eyes,  and  speech  almost  perfect,  he  evidently 
had  been  very  much  misunderstood,  and  so  mismanaged  as  to  bring 
out  the  worst  in  his  nature.  He  was  stealthy,  destructive,  obstinate, 
passionate,  untruthful,  and  untrustworthy,  dangerous  with  fire  and 
seemed  destitute  of  natural  affection.  Could  read,  write  and  care 
for  himself.    Powers  of  attention,  imitation  and  memory  good. 

After  12  years  of  careful  and  persistent  training,  he  has  developed 
into  a  handsome  young  man,  erect  with  graceful  bearing,  quiet, 
gentle,  thoughtful,  courteous ;  indeed  one  of  whom  any  mother 
might  be  proud.  Is  a  remarkably  good  cornetist,  plays  beautifully 
on  the  violin  and  is  invaluable  in  both  band  and  orchestra.  Has  com- 
pleted school  course,  writes  an  excellent  letter,  is  well  up  in  the  cur- 
rent events  of  the  day,  and  is  an  experienced  printer  and  proof- 
reader. 

Father  26,  and  mother  24,  at  time  of  child's  birth.  First-born ; 
difficult  labor,  but  no  instruments ;  fed  artificially.  Mother  is  of  very 
nervous  temperament.  Mother's  uncle  died  insane.  Father  died  of 
phthisis.  S.  seemed  perfectly  well  until  his  third  year,  when  one  day 
at  table,  he  suddenly  lost  consciousness,  became  rigid,  and  did  not 
recover  for  over  30  minutes,  the  effect  being  to  render  him  fever- 
ish and  irritable  throughout  the  day.  He  had  3  similar  attacks  at 
intervals  of  2  years,  but  none  since. 

Imbeciles  by  Deprivation. 

Case  A. — F.  C.  Middle-grade.  An  interesting  boy  of  10  years. 
A  deaf-mute  with  adenoid  growths.  Brown  eyes ;  no  ears — simply 
two  little  lumps  of  flesh  without  any  external  opening.  Head  cov- 
ered with  a  soft  down  in  place  of  hair.  Was  interested  in  all 
about  him,  and  used  his  hands  well.  Sent  to  kindergarten,  im- 
proved, learning  to  sew,  darn  stockings,  and  knit — always  happy 
when  occupied.  Was  trained  in  simple  household  duties,  and  later 
did  excellent  work  in  shoe-shop.    Nothing  is  known  of  family  history. 

Case  B. — J.  B.  Middle-grade ;  a  man  of  probably  30  years. 
Asymmetry  of  head.  A  deaf-mute,  who  taught  himself  to  talk ; 
knows  everything  that  is  going  on  in  the  institution.  Is  quite  con- 
versant with  certain  historical  facts,  and  with  general  topics  of  the 
day.  Having  learned  in  a  fashion  of  his  own  to  read  and  write, 
keeps  a  diary  of  current  events  and  is  a  veritable  encyclopedia.  Often 
cruel  to  younger  children,  he  is  devoted  to  animals,  having  great 
influence  over  them — especially  turtles,  snakes,  and  opossums.  Is 
an  excellent  worker  in  the  shoe-shop.     With  a  keen  sense  of  the 


AMERICAN    INDIAN    TYPE.  287 

ridiculous  is  quick  to  catch  a  joke.  Has  a  habit  of  coolly  appro- 
priating anything  that  strikes  his  fancy,  but  is  on  the  whole  very 
interesting. 

Nothing  is  known  of  his  family,  and  but  little  of  his  previous 
history  except  that  as  an  acrobat  he  had  a  fall  in  a  circus,  injuring 
his  head. 

Negroid  Type. 

Case  A. — R.  L.  Low-grade  girl,  16  years  old.  Negroid  cast 
of  countenance.  Skin  "  mulatto-colored."  Hair  black,  coarse  and 
straight.  Eyes  black,  large  and  prominent.  Head  "  bullet  shaped," 
frontal  region  comparatively  undeveloped.  Flat  nose,  thick  lips, 
often  apart,  teeth  defective.  Tone  of  voice  guttural,  and  articulation 
imperfect  in  the  very  few  words  attempted.  Trained  in  house  work, 
and  care  of  children. 

But  little  known  of  family  history,  except  that  her  people  were 
not  negroes,  but  ignorant  whites,  who  attributed  her  condition  to  a 
"  severe  fall,  when  five  weeks  old." 

Case  B. — Q.  S.  Low-grade  imbecile  woman,  epileptic,  aged  31 
years.  Skin  darker  than  that  of  a  mulatto.  Eyes  black  and  beady ; 
ptosis  marked.  Hair  jet  black,  curly  and  glossy.  Nose  broad  and 
flat.  Large  mouth;  thick  coarse  lips.  Very  defective  articulation. 
Went  to  school,  but  mental  limit  was  soon  reached.  Sluggish  habits 
precluded  any  advance  in  industrial  work.  Has  deteriorated,  and  is 
now  a  subject  for  asylum  care. 

Father,  a  merchant,  55,  and  mother  23  years,  at  time  of  Q.'s  birth. 
Mother  very  hysterical,  died  a  year  after  of  phthisis.  Maternal 
grandfather  developed  epilepsy  late  in  life.  A  half-brother,  son  of 
the  father  by  a  former  marriage,  is  of  much  the  same  type,  yet  there 
is  no  trace  in  the  family  of  an  admixture  of  negro  blood. 

American  Indian  Type. 

Case  A. — D.  R.  High  grade,  male,  27  years  old.  Slender  erect 
figure  and  bearing  good.  High  cheek  bones,  prominent  nose,  and 
sharp-pointed  chin  gives  a  wedge  shape  to  the  face,  which  together 
with  tawny  complexion,  and  straight  coarse  dark  hair,  presents  a 
marked  resemblance  to  an  Indian.  Forehead  peculiarly  wrinkled. 
Enunciation  slightly  defective,  and  speaking  voice  husky  and  rough, 
although  a  good  baritone  in  singing.  Is  a  fair  cornetist,  and  a  re- 
markably fine  drummer ;  also  manages  the  "  traps  "  in  the  band  to 
perfection.  Is  good  in  house  service,  and  fair  in  carpentry.  Is  an 
omnivorous  reader,  and  writes  an  excellent  letter.  Nothing  is  known 
of  family  history. 


288  ILLUSTRATIVE    CASES. 


Mongolian  Type. 


Case  A. — S.  G.  Boy;  aged  15  years  when  photograph  was  taken. 
Low  grade,  with  the  characteristics  of  his  class,  was  unimprovable, 
except  in  the  attainment  of  some  simple  industrial  occupation.  Be- 
came, through  training,  quite  a  good  worker  in  laundry,  running 
machines,  etc.  Decidedly  under  size.  Figure  slight  and  erect.  Head 
brachycephalic ;  face  a  pointed  oval.  Skin  soft  and  of  a  yellowish 
color ;  eyes  dark,  almond-shaped  and  set  obliquely ;  nose  pointed ; 
ears  "  pitcher-shaped,"  prominent  and  planted  far  back.  Hair  on 
head  brown,  soft,  straight  and  fairly  abundant,  but  on  face  and  body, 
sparse.  Tongue  large,  pointed,  fissured  and  papillae  much  hyper- 
trophied ;  teeth  poor.  Speech  guttural,  very  imperfect,  certain  articu- 
late sounds  being  impossible.  Hands  broad,  fingers  short  and 
stumpy,  integument  coarse.  Heart  defective ;  circulation  poor. 
Good  natured,  but  obstinate  at  times ;  has  a  keen  sense  of  the  ridicu- 
lous and  some  faculty  of  imitation.    Has  an  excellent  memory. 

Father  43,  mother  31  years  of  age,  at  the  birth  of  this,  their  eighth 
child.  Born  at  full  term ;  ordinary  labor ;  nourished  by  mother. 
Was  a  weak  babe,  the  mother  sustaining  a  severe  mental  shock 
during  pregnancy.  Did  not  learn  to  walk  until  4  years  old,  and  had 
"  brain  disease  "  at  5. 

Mother  died  at  44,  of  cancer  of  uterus.  Father  died  of  general 
exhaustion.  Paternal  grandfather  died  of  phthisis,  and  maternal 
grandmother  of  heart  disease. 

Case  B. — M.  F.  Female;  aged  23  when  photograph  was  taken. 
Low-grade  imbecile,  trained  to  habits  of  self-help  and  to  aid  in 
simple  household  occupations.  Obstinate  and  disobedient  at  times, 
but  fairly  tractable  and  affectionate.  Powers  of  mimicry  good, 
seeing  the  ridiculous  quickly.  Undersized.  Head  brachycephalic ; 
broad  forehead  and  pointed  chin,  giving  an  oval  face.  Skin  coarse 
and  tawny.  Hands  broad ;  fingers  short  and  stumpy.  Gruff  guttural 
voice.  Ears  set  far  back  but  of  normal  size.  Eyes  dark,  almond 
shaped  and  oblique.  Hair  dark  brown,  stiff,  wiry,  and  fairly 
abundant. 

Father,  a  wheel-wright,  aged  50,  and  mother  an  imbecile,  aged  49 
at  time  of  the  birth  of  M.  who  was  the  sixth  of  nine  children. 
Nourished  by  mother  who,  during  gestation,  in  abject  poverty,  often 
suffered  from  hunger. 

A  sister,  brother,  and  the  father  became  insane,  the  two  latter  com- 
mitting suicide,  and  M.  herself  in  her  thirty-first  year  also  became 
insane  with  homicidal  and  suicidal  tendencies.  Paternal  grandfather 
died  of  phthisis. 

Case   C. — D.   J.     Boy ;   aged    18  years.  .  A   superficial   apathetic 


MONGOLIAN    TYPE.  289 

idiot.  Semi-mute,  speaking  only  a  few  words ;  enunciation  very 
imperfect.  Understands  simple  language.  Learned  to  feed  himself 
and  is  cleanly  in  habits.  Dwarfish  in  stature ;  squat  figure ;  slouching 
gait ;  drooping  posture ;  tailor  fashion  in  sitting.  Head  brachy- 
cephalic ;  forehead  flat  and  wrinkled  transversely.  Hair  brown  and 
somewhat  scanty.  Eyes  oblique,  set  rather  close  together;  there  is 
photophobia,  and  chronic  conjunctivitis.  Nose  flat;  ears  "pitcher- 
shaped,"  and  implanted  well  back.  Tongue  very  large,  filling  the 
mouth  completely,  fissured  deeply,  papillae  being  much  enlarged. 
Skin  a  muddy  yellow ;  hands  broad  and  fingers  short  and  thick.  Cir- 
culation feeble.     Nothing  is  known  of  family  history. 

Case  D. — G.  P.  Boy;  aged  10  years.  Superficial  excitable  idiot. 
Choreic.  Semi-mute.  Became  in  2  years  cleanly  in  habits  and 
able  to  feed  himself.  Restless  and  quick  in  movement.  Extremities 
small.  Had  a  habit  of  crossing  legs  tailor  fashion.  Head  brachy- 
cephalic.  Hair  dark  brown  and  scanty.  Ears  large  and  very  promi- 
nent. Eyes  oblique ;  chronic  conjunctivitis.  Skin  yellowish.  Mouth 
wide ;  tongue  long,  thick,  pointed,  and  fissured.  Nose  wide.  Circu- 
lation poor. 

Family  history  good.  Father  a  machinist,  was  41,  and  mother  38 
years  old,  at  time  of  G.'s  birth.  Sixth  child,  born  at  full  term, 
nourished  by  mother. 

Case  E. — A.  W.  Male;  idio-imbecile,  epileptic,  aged  24;  under- 
sized. Improved  in  self-help,  and  as  aid  in  the  nursery.  Had  right 
inguinal  hernia.  Testicles  slow  in  descending.  Head  brachy- 
cephalic.  Face  narrowed  at  jaws.  Ears  prominent,  set  far  back. 
Nose  pointed.  Eyes  markedly  almond-shaped,  convergent  strabis- 
mus, chronic  conjunctivitis  and  advanced  entropion,  with  absence  of 
cilia.  Hair  black,  stiff,  wiry,  and  scant.  Skin  tawny  and  coarse. 
Lips  thick  and  constantly  apart.  Tongue  large,  thick,  deeply 
fissured,  and  papillae  greatly  hypertrophied.  Hands  broad,  fingers 
thick  and  clumsy.  Circulation  defective ;  liable  to  chilblains.  Diges- 
tion weak. 

First-born  of  4  sons,  slow  delivery,  owing  to  contracted  pelvis. 
Mother  thrown  from  carriage  3  months  previous  to  child's  birth. 
Mother  hysterical  and  ignorant ;  father  an  invalid  and  slightly  lame. 


19 


CHAPTER   XVIII. 

illustrative  cases  {continued). 

Craniectomy;  Cretinism;  Myxcedema;  Microcephalus ; 
Hydrocephalus;  Idiots  Savants;  Insanity. 

Craniectomy. 

Case  A. — C.  B.  Girl,  epileptic;  aged  16  years.  Superficial  ex- 
citable idiot ;  semi-mute,  able  only  to  feed  herself.  Mischievous,  de- 
structive, unclean,  and  hard  to  manage.  Nervous  and  restless,  con- 
stantly in  motion,  running  and  walking  to  and  fro.  Unconscious  of 
danger,  quarrelsome,  pinching  and  biting  other  children,  herself  in- 
sensitive to  pain. 

Craniectomized  at  8  years  of  age;  became  more  nervous,  con- 
tinually tearing  face  and  clothing  and  picking  at  wood-work. 
Spasms  increased  in  force  and  frequency,  as  did  her  restlessness  and 
cruelty;  would  attack  anyone  within  reach.  Filthy  day  and  night, 
retrograded  rapidly. 

First-born ;  full  term ;  nourished  by  mother  who  was  much  troubled 
during  pregnancy.  Father  a  carpenter,  aged  25,  and  mother  24,  at 
time  of  child's  birth. 

Case  B. — F.  B.  Boy;  aged  11  years.  Superficial  apathetic  idiot; 
epileptic.  Semi-mute ;  sight  and  hearing  good.  Understands  simple 
language.  Is  partially  paralyzed  and  very  frail.  Can  feed  himself 
but  is  otherwise  helpless. 

Linear  craniectomy  was  performed  when  7  years  old,  without  the 
slightest  improvement  resulting. 

First-born,  full  term,  labor  ordinary.  Father,  an  artisan,  aged 
24,  and  mother  22,  at  time  of  F.'s  birth. 

Case  C. — M.  R.  Male;  aged  20  years.  Middle-grade.  Well- 
formed;  blue  eyes,  red  hair.  Nervous,  erratic,  loquacious,  and  an 
egoist ;  affectionate,  obstinate  at  times,  and  noisy.  Unable  to  concen- 
trate his  attention  for  any  length  of  time;  can  sometimes  read  and 
write  quite  well,  and  again,  not  at  all. 

In  his  twelfth  year  his  parents  were  induced,  although  there  was 
no  sign  of  pressure  on  the  brain,  to  have  craniectomy  performed  with 
hopes  of  mental  improvement,  which  have  not  been  realized. 

Third-born ;  full  term ;  ordinary  labor.  Mother  profoundly 
shocked    3    weeks    before  M.'s    birth.     Father    a    miner,    was    26, 

290 


CRANIECTOMY.  29 1 

and  mother  25,  at  time  of  child's  birth.  M.  developed  epilepsy  at 
4  months,  which  continued  until  the  fifth  year,  when  he  was  circum- 
cised; no  spasms  since. 

Case  D. — C.  H.  Boy;  aged  19  years.  Middle-grade.  Was 
craniectomized  at  12  years  of  age  and  came  to  me  a  year  later. 
Sight,  speech  and  hearing  normal.  Extremely  nervous,  active,  noisy, 
but  affectionate,  obedient  and  truthful.  Tidy  in  dress  and  cleanly 
in  habits.  Powers  of  attention,  imitation,  and  memory  fair.  Could 
count  his  ten  fingers,  but  knew  nothing  of  color,  form,  or  alphabet. 
In  kindergarten,  improved  slowly;  began  to  imitate  motions  in 
games  and  to  sing.  To  copy  the  alphabet  and  to  weave  paper  mats 
was  the  extent  of  his  attainments,  and  within  two  years  his  mental 
limit  reached,  he  became  quarrelsome,  easily  excited  and  his  attention 
diverted  by  any  trifle.  In  appearance  he  looks  brighter  than  he  really 
is,  for,  losing  both  memory  and  hand  power,  he  is  steadily  deterior- 
ating, not  the  slightest  improvement  having  resulted  from  the 
operation. 

First-born ;  at  full  term ;  instrumental  delivery  to  which  mental 
condition  is  attributed;  nourished  by  mother,  and  apparently  strong 
and  healthy  until  seventh  month,  when  he  had  meningitis.  Seemed 
different  from  other  children ;  slow  and  peculiar,  could  not  get  along 
in  ordinary  public  school.  Father,  a  piano-key  maker — dying  of 
anaemia  at  the  age  of  42 — was  34,  and  mother — very  deaf — aged  19 
at  time  of  C.'s  birth. 

Case  E. — M.  C.  Female,  aged  23  years.  High-grade.  Came 
under  my  care  when  9  years  old.  Choreic  movements  of  face,  pow- 
ers of  attention,  imitation,  and  memory,  excellent.  Could  read  and 
write,  sing,  distinguish  color  and  form  and  care  for  herself  in 
every  way.  Did  well  in  school,  but  affected  and  silly  at  times. 
Mental  limit  reached  at  15,  when  she  became  a  pronounced  nympho- 
maniac; formed  violent  attachments  for  girls,  and  was  fond  of  at- 
tracting the  attention  of  boys. 

In  her  seventeenth  year,  her  mother  being  persuaded  that  imbe- 
cility could  be  cured,  craniectomy  was  performed.  Exhibited  as  a 
phenomenon  in  the  hospital,  and  tributes  paid  to  the  surgeon's  won- 
derful skill,  there  was  nevertheless  not  the  slightest  improvement  in 
,  her  condition. 

First-born,  at  full  term ;  instrumental  delivery.  Father  a  drunk- 
ard, was  42  and  mother,  forced  to  leave  him  in  fifth  month  of  her 
pregnancy,  was  18  at  time  of  M.'s  birth.  Paternal  grandfather,  a 
drunkard,  died  of  cancer  of  the  mouth. 

Case  F. — F.  E.  Boy;  aged  11  years.  Epileptic.  High  grade. 
Coming  to  me  at  the  age  of  7  years,  immediately  after  an  operation 
of  linear  craniectomy,  he  was  a  bright-faced  attractive  boy,  with 


292  ILLUSTRATIVE    CASES. 

black  eyes  and  hair ;  erect  and  good  physique.  Speech,  sight,  and 
hearing  perfect.  Affectionate,  truthful,  obedient,  tidy  in  dress, 
cleanly  in  habits.  Table  manners  excellent.  Understood  language 
and  had  a  fair  vocabulary.  Powers  of  imitation  and  memory  good, 
but  attention  poor.  Knew  nothing  of  color,  form  or  number. 
Upon  entering  the  kindergarten,  was  inclined  to  be  a  little  slow,  but 
when  stimulated,  responded  and  became  eager  to  learn.  Sense  of 
perception  developed  rapidly.  Readily  recognized  articles  by  touch. 
Developed  an  excellent  singing  voice.  Learned  to  march  and  dance 
gracefully.  Passionately  fond  of  music,  and  animals,  learned  to 
read,  write,  to  draw  and  model  in  clay. 

In  his  ninth  year  there  was  a  sudden  change  in  his  moral  nature. 
Became  stubborn,  disobedient,  untruthful,  and  a  kleptomaniac,  steal- 
ing articles  for  which  he  had  no  use,  covering  up  his  tracks  with 
the  utmost  cleverness.  He  began  to  grow  silly  and  there  was  a  re- 
currence of  epileptic  attacks,  from  which  there  had  been  immunity 
for  five  years.  There  was  a  marked  change  also  in  mental  condi- 
tion, and  he  would  sit  listless  or  aimlessly  scribbling  on  slate  or 
paper.  Within  two  years,  as  spasms  gradually  decreased  and  finally 
ceased,  he  emerged  from  this  lethargy  and  returned  to  his  former 
condition — moral  and  mental.  His  improvement  I  consider  due  to 
the  cessation  of  the  spasms,  training,  and  treatment,  and  to  the  indi- 
vidual care  he  has  received.  I  can  see  no  benefit  traceable  to  the 
craniectomy. 

Fourth-born,  full  term ;  labor  ordinary.  Apparently  normal  when 
born,  had  several  falls  during  infancy,  but  nothing  unusual  was 
noticed  until  at  12  months,  after  an  attack  of  whooping-cough  he 
appeared  peculiar,  and  at  3  years  developed  epilepsy. 

Father  a  stone-cutter,  was  37 ;  mother  29,  when  F.  was  born. 
Family  history  excellent. 

Case  G. — K.  J.  Boy ;  aged  19  years  ;  high  grade.  When  coming 
to  me  in  his  fifteenth  year,  6  months  after  he  was  craniectomized, 
was  dreamy,  and  extremely  nervous.  Had  had  the  habit  as  late  as 
his  tenth  year  of  sucking  his  thumb  and  of  pulling  his  hair ;  had 
pulled  almost  all  the  hair  off  the  top  of  his  head.  Had  been  allowed 
to  smoke  cigarettes  inordinately  during  his  twelfth  year.  Could  not 
concentrate  attention ;  desired  constant  change.  Dark  hair  and 
eyes ;  pleasant  expression.  Obedient,  affectionate,  and  truthful. 
Recognized  color  and  form,  and  could  read,  write  and  cipher.  Pow- 
ers of  attention,  imitation,  and  memory  good.  Sight,  hearing,  and 
speech  perfect.  Took  delight  in  trees,  birds,  and  flowers.  Did  well 
in  purely  mental  work,  but  having  little  idea  of  proportion,  and 
measurement,  manual  training  was  at  first  difficult.  In  this,  how- 
ever,  he   has   improved   and   does   beautiful   work    in   sloyd.     Im- 


Plate   XLIX. 


o      I 


CRETINISM.  293 

provement  was  due  in  no  way  to  operation,  but  to  careful,  patient 
training. 

First-born ;  instrumental  delivery ;  nourished  by  mother  for  first 
few  weeks,  and  then  fed  artificially.  Was  a  weak,  cross,  sickly  babe. 
Slow  in  developing,  in  walking,  talking,  and  in  general  intelligence. 
At  6  years  had  a  severe  fall,  striking  on  his  face.  Father — a  paper 
hanger — and  mother,  were  each  21  when  K.  was  born.  Father 
healthy;  mother  delicate,  phthisical  and  nervous — any  excitement 
inducing  fainting  spells — died  at  33  of  paralysis,  as  had  also  her 
father.  Father  and  both  grandfathers  drank  moderately.  The 
father  says  of  his  family :  "A  close  examination  might  place 
some  of  us  below  the  average  scale  of  intelligence — not  feeble- 
minded or  insane,  but  usually  termed  queer." 

For  additional  cases,  see  "  E  "  and  "  F  "  of  Microcephalics. 

Cretinism. 

Case  A. — P.  C.     Coy ;  16  years  old.     Low  grade.     Height  4  feet 

2  inches ;  weight  6yj4  pounds.  Blue  eyes,  red  hair,  sight  and  hear- 
ing perfect.  Speech  somewhat  indistinct,  and  vocabulary  limited. 
Powers  of  attention,  comprehension,  imitation,  and  memory  fair.  Is 
active,  noisy,  amiable,  affectionate,  truthful,  neat  in  dress  and  cleanly 
in  habits.  Can  wash  and  dress  himself,  and  is  helpful  about  the 
house. 

Delicate  from  birth ;  did  not  learn  to  walk  until  fourth  year, 
when  his  cretinous  condition  was  first  recognized.  A  mute,  he  pre- 
sented all  the  characteristics  of  a  typical  cretin,  until  his  tenth  year, 
when  placed  on  thyroid  (two  and  one  half  grains  extract,  three  times 
a  day),  the  improvement  was  marked,  both  mental  and  physical; 
he  grew  6  inches,  improved  in  speech,  and  brightened  in  every  way. 

Eleventh  child,  born  at  full  term  ;  hard  labor  ;  nourished  by  mother 
for  2  years,  who  when  3  months  pregnant  nursed  4  of  her  children 
with  scarlet  fever.  Father,  a  laborer,  was  45  and  mother  40,  at 
time  of  P.'s  birth. 

Case  B. — M.  R.     Female.     Low  grade,  aged  21  years.     Height 

3  feet  4  inches ;  weight  55^  pounds.  Sight  and  hearing  perfect. 
Gray  eyes,  auburn  hair,  clay-colored  skin,  large  mouth,  protruding 
tongue,  indistinct  speech,  and  waddling  gait ;  abdomen  large  and 
pendulous.  Very  sluggish  in  movements  and  physiologically  old. 
Disposition  amiable  and  affectionate.  Came  under  special  training 
in  eighth  year.  In  kindergarten  9  years  with  no  practical  result. 
Learned  to  eat  with  a  spoon  and  became  quite  cleanly  in  habits. 
Thyroid  treatment  tried,  but  was  found  too  severe  for  a  constitution 
so  delicate. 


294  ILLUSTRATIVE    CASES. 

M.  was  born  at  full  term ;  ordinary  labor ;  nourished  by  mother. 
Father,  a  laborer,  died  of  phthisis,  as  did  also  the  mother. 

Case  C. — N.  L.  Boy ;  of  middle-grade,  aged  5  years.  Height  3 
feet  3  inches  ;  weight  34^  pounds.  Clay-colored  complexion ;  pend- 
ulous abdomen ;  head  brachycephalic ;  hair  dark  red,  thick  and  fine. 
Face  square,  bridge  of  nose  flattened,  nostrils  dilated.  Tongue  is 
large;  teeth  badly  decayed.  Ears  large  and  prominent.  Eyes 
brown,  set  far  apart.  Circulation  poor,  extremities  cold;  red  spots 
on  cheeks.  Speech  very  defective  and  vocabulary  small.  Sluggish 
in  habit.  Gentle,  amiable,  affectionate,  obstinate ;  has  a  violent  tem- 
per when  roused.  Powers  of  attention,  imitation,  and  memory  fair. 
Unable  to  wash,  dress,  or  care  for  himself  in  any  way. 

First-born,  dry  birth,  premature,  labor  difficult.  Fed  artifi- 
cially during  first  month,  then  nourished  by  negro  nurse  for  two 
weeks,  and  afterwards  by  mother.  A  sickly  infant  with  defective 
heart;  had  a  slight  attack  of  meningitis  when  6  days  old,  asso- 
ciated with  spasms.  During  the  first  and  latter  months  of  preg- 
nancy the  mother  suffered  from  fatigue  of  journey,  anxieties  from 
proximity  of  yellow  fever,  and  within  a  few  weeks  of  delivery  sus- 
tained a  severe  fright.  Father  25,  mother  23,  at  time  of  N.'s  birth. 
Family  history  good.  Environment  not  of  the  best — being  a  malari- 
ous district  in  the  far  south — an  entire  change  was  deemed  advisable. 

Upon  coming  to  me,  he  was  placed  at  once  on  thyroid,  2^  grains 
of  the  dried  extract  being  administered  daily  in  divided  doses.  The 
effect  was  immediate  increase  of  temperature  and  loss  of  appetite. 
A  gradual  reduction,  first  to  one  half  and  then  to  one  fourth  of  the 
quantity  still  producing  very  unpleasant  effects,  I  was  forced  finally 
to  abandon  it.  Extreme  fragility  of  constitution  gave  no  hope  of 
resisting  the  rigors  of  a  northern  climate,  and  in  fact,  demanded  a 
return  home. 

Myxgedema. 

Three  sisters  closely  resembling  one  another.  Each  has  the  char- 
acteristic round  "  moon  face,"  double  chin,  wide  flat  nose,  large 
mouth,  thickened  lips,  and  yellowish  complexion  with  red  patches 
on  cheeks.  Expression  placid  and  good-natured.  Flesh  firm ;  does 
not  pit  on  pressure.  Skin  dry,  secretions  scanty,  hair  dry  and  brit- 
tle, as  are  also  nails.  Hands,  feet,  and  eyelids  swollen.  Thyroid 
glands  atrophied,  temperature  below  normal,  averaging  963/2  °. 
Mental  processes  slow,  speech  difficult  and  hesitating;  vocabulary 
limited. 

Case  A. — A.  M.  Female;  aged  30.  Low  grade;  weight  180% 
pounds,  height  4  feet  n*4  inches.  Epileptic,  spasms  infrequent,  but 
very  severe.     A  nymphomaniac.     Is  nervous,  hysterical,  very  sensa- 


MICROCEPHALUS.  295 

tional  and  has  delusions  of  persecution.  Is  irritable,  stubborn,  and 
obstinate.  Has  learned  to  do  simple  house-work.  There  has  been 
gradual  but  persistent  increase  in  size  during  17  years. 

Case  B. — L.  M.  Female,  aged  33.  Low  grade;  weight  258^ 
pounds,  height  5  feet  1^4  inches.  A  nymphomaniac.  Is  irritable, 
suspicious,  vulgar,  profane,  untruthful,  and  obstinate.  Has  delu- 
sions of  persecution.     Can  assist  in  housework,  in  clumsy  fashion. 

Steadily  increasing  in  size  for  the  last  20  years,  has  just  as  steadily 
deteriorated  mentally. 

Case  C. — B.  M.  Female,  aged  38.  Low  grade;  weight  198^ 
pounds,  height  5  feet  V/2  inches.  A  nymphomaniac.  Amiable  and 
manageable.  Can  do  housework  and  is  an  excellent  nurse  for  small 
children. 

Each  of  the  three  sisters  was  born  at  full  term.  Ordinary  labor; 
nourished  by  mother.  Were  all  large  babies,  and  all  unusually  large 
during  infancy  and  childhood.  Parents,  both  "  Pennsylvania 
Dutch."  Father,  a  laborer,  drank  moderately ;  died  about  40  years 
of  age  of  phthisis. 

Microcephalous. 

Case  A. — W.  M.  Male;  superficial  excitable  idiot;  aged  IOJ4 
years  when  photograph  was  taken.  Height  3  feet  11%  inches, 
weight  44  pounds.    Head,  microbrachycephalic. 

Head  Measurements. 

Inches. 

Circumference    1554 

Naso-occipital  arc 10^ 

Binauricular  arc 10^ 

Antero-posterior    diameter sVk 

Greatest  transverse  diameter 3% 

Binauricular    diameter 3^2 

Facial  length 10^ 

Cephalic  index   77 

A  mute,  with  dark  hair  and  gray  eyes.  Teeth  fair ;  alveolar 
arches  wider  than  usual,  and  palate  almost  flat.  Sight,  hearing, 
taste,  and  smell  apparently  normal.  Helpless,  with  marked  sialor- 
rhoea,  he  is  unable  to  walk  or  to  care  for  himself ;  spends  most  of  the 
day  in  the  rocking-chair.  Is  insensitive  to  pain,  extremely  nervous, 
restless,  and  noisy,  never  quiet  when  awake,  with  pronounced  im- 
perative movements  that  follow  a  regular  cycle  thus :  First,  throws 
up  head  and  places  left  thumb  in  mouth  with  fingers  resting  on  left 
cheek  while  he  rocks  to  and  fro ;  bending  low,  he  straightens  and 
turns  to  right,  at  the  same  time  placing  right  hand  at  nape  of  neck ; 
next  throws  left  arm  to  right  shoulder ;  crosses  wrists,  strikes  right 
side  of  face  under  ear  with  right  hand  and  strikes  hands  together ; 


296  ILLUSTRATIVE    CASES. 

then  wrings  hands  with  imperative  movements  of  fingers,  and  places 
right  index  finger  in  left  palm ;  places  left  index  finger  to  lips,  thumb 
in  mouth ;  waves  both  hands,  and  crosses  feet.  This  he  does  con- 
stantly when  awake,  with  brief  intervals  between  cycles,  during 
which,  more  quickly  than  the  eye  can  follow,  he  pulls  and  picks  at 
clothing.  Organs  and  functions  of  body  normal,  except  for  occa- 
sional attacks  of  gastro-intestinal  disturbance. 

Under  treatment  for  7  years,  learned  only  to  feed  himself  with  a 
spoon,  and  became  more  cleanly  in  habits,  indicating  his  wants  by  a 
peculiar  wailing  cry. 

Second  child ;  born  at  full  term ;  labor  ordinary ;  nourished  by 
mother.  Father,  a  laborer,  26  years,  and  mother  24,  at  time  of  W.'s 
birth.  Two  sisters  living,  both  healthy.  Parents  of  "  Pennsylvania 
Dutch "  stock.  No  cause  for  W.'s  condition  assigned.  Died  in 
twelfth  year,  of  intussusception. 

At  the  necropsy  the  body  weighed  45.64  pounds  and  measured  3 
feet  n^4  inches.  Calvarium  thin,  measuring  at  cut  portions  but 
one  eighth  of  an  inch.  Brain  not  especially  edematous,  and  only 
a  moderate  amount  of  cerebro-spinal  fluid  escaped.  Dura  adherent 
to  pia  over  whole  cerebral  hemispheres,  and  in  some  places  to  the 
calvarium,  so  that  the  latter  was  removed  with  great  difficulty. 
Brain  weighed  20.64  ounces. 

The  cerebral  hemispheres  were  of  equal  size — each  hemisphere 
measuring  antero-posteriorly  5  inches — and  did  not  cover  the  cere- 
bellum, about  one  inch  of  each  cerebellar  lobe  being  left  exposed. 
The  fissure  of  Rolando  on  each  side  was  nearly  perpendicular.  The 
cerebral  convolutions  were  very  imperfectly  developed,  especially  in 
each  parietal  lobe.  The  cerebellum  measured  transversely  4.14 
inches,  and  was  much  better  developed,  proportionately,  than  the 
cerebrum.  The  occipital  lobes  were  separated  from  one  another, 
and  the  left  superior  vermis  was  exposed.  The  cranial  nerves  were 
normal,  and  the  pons  was  well  developed.  The  spinal  cord  was 
about  as  large  as  is  usual  in  a  child  of  the  same  size. 

Case  B. — W.  P.  Male,  superficial  excitable  idiot,  aged  10  years. 
Height  3  feet  y^/4  inches,  weight  40  pounds.  Head,  microbrachy- 
cephalic,  resembles  a  cocoanut  in  size  and  shape. 


Head  Measurements.  inches. 

Circumference  14% 

Naso-occipital  arc   9 

Binauricular    arc 97A 

Antero-posterior    diameter 5% 

Greatest  transverse  diameter 4 

Binauricular    diameter ZTA 

Facial  length  SV2 

Cephalic  index   77 


MICROCEPHALUS.  297 

A  semi-mute  with  brown  hair  and  eyes.  Large  mouth,  thick  lips, 
prominent  teeth,  alveolar  arches  wider  than  normal,  and  palate  al- 
most flat.  Sialorrhcea  marked.  Sight  and  hearing  normal ;  taste 
and  smell  very  acute.  Is  left-handed  and  fingers  are  clubbed.  Mus- 
cular development  fair,  is  very  active  and  has  a  peculiar  "  running  " 
gait.  Obstinate,  but  not  sullen,  has  a  violent  temper  and  when 
roused  will  throw  himself  upon  the  floor,  beating  his  head  with  his 
hands.     Is  eager  to  attract  attention  and  excite  sympathy. 

When  first  brought  to  me,  in  his  seventh  year,  was  as  wild  and 
untrained  as  any  animal  of  field  or  wood.  In  first  and  second 
years  he  improved  in  matters  of  self-help,  becoming  more  cleanly  in 
habits  and  able  to  feed  and  dress  himself  with  very  little  assistance. 
Very  imitative,  he  will  attempt  to  do  anything  that  excites  his  inter- 
est, delighted  to  aid  in  polishing  floors  and,  understanding  simple 
commands,  is  fairly  obedient. 

Under  training  in  articulation  he  began  to  call  his  play-fellows 
by  name  and  to  use  short  phrases :  "  I  wont,"  "  Come  here,"  "  You 
can't  get  it."  Will  laugh  and  tap  his  head  when  asked  "  Who  is 
dumb  ?  "  and,  showing  a  power  of  associaton,  he  will  make  the  same 
gesture  when  required  to  do  anything  to  which  he  is  disinclined. 
Will  defend  himself  from  other  children  if  imposed  upon,  yet  is 
generous  and  affectionate  toward  them,  and  always  willing  to  share 
any  sweetmeats. 

First-born,  at  full  term ;  labor  ordinary ;  was  nourished  by  mother 
who  during  fourth  month  of  gestation  was  frightened  by  an  organ- 
grinder's  monkey  jumping  into  her  lap.  Father  an  Austrian  by 
birth,  by  occupation  a  miner,  was  20  years  of  age,  and  mother,  a 
Prussian,  was  17  at  time  of  child's  birth. 

Cases  C  and  D. — J.  and  R.  C.  Twin  brothers,  aged  7^2  years. 
Profound  excitable  idiots.     Heads,  microbrachycephalic. 

J. — Height  3  feet,  6y2  inches ;  weight  36  pounds. 

Head  Measurements.  inches. 

Circumference  16% 

Naso-occipital   arc 10 T/i 

Binauricular  arc 95A 

Antero-posterior  diameter SXA 

Greatest  transverse  diameter 4 

Binauricular  diameter 3JA 

Facial  length 5^ 

Cephalic  index   77 

R. — Height  3  feet  7  inches  ;  weight  33 ^  pounds. 

Head  Measurements.  inches. 

Circumference  1534 

Naso-occipital  arc   ioj^ 


298  ILLUSTRATIVE   CASES. 

Inches. 

Binauricular  arc  9% 

Antero-posterior    diameter 5% 

Greatest  transverse  diameter 4 

Binauricular  diameter 3^2 

Facial  ^length    5^2 

Cephalic  index   77 

These  children  resemble  each  other  so  closely  that  it  is  almost 
impossible  to  distinguish  one  from  the  other,  except  that  J.  has  a 
supernumerary  thumb  on  right  hand.  Alveolar  arches  are  wider 
than  normal,  and  the  palate  is  almost  flat  in  both  cases. 

Both  have  light  hair  and  blue  eyes,  and  are  absolute  mutes.  When 
pleased  they  give  frequent  bird-like  cries,  consisting  of  one  shrill  pro- 
longed note  repeated  at  intervals.  They  are  healthy,  active  little  fel- 
lows, docile,  affectionate,  recognizing  readily  their  playmates  and 
those  in  daily  attendance  upon  them.  Destructive,  but  not  more  so 
than  are  many  nervously  active  babies  of  two  years,  which  is  about 
their  stage  of  development,  being  quite  as  incapable  of  self -protection 
or  self-help.  Habits  unclean ;  sialorrhoea  marked.  They  are  restless 
and  climb  with  the  agility  of  cats,  though  muscular  incoordination  is 
noticed  in  the  shuffling,  dragging  uncertain  gait.  Powers  of  atten- 
tion and  imitation  poor,  but  curiosity  excessive,  and  temper  quick. 
In  these  cases  there  is  not  the  slightest  hope  of  improvement. 

Father,  a  cabinet-maker  by  trade,  is  a  pronounced  dipsomaniac, 
subject  to  severe  attacks  of  headache;  was  42,  and  mother  34,  at  time 
of  twins'  birth.  Born  at  full  term ;  labor  ordinary.  Conception  took 
place  while  father  was  in  a  state  of  intoxication,  and  the  mother  who 
kept  a  boarding-house,  was,  during  pregnancy,  burdened  with  the 
care  of  another  microcephalic  epileptic  child.  J.  and  R.  were  the 
fourth  and  fifth  of  a  family  of  five  children  (all  boys)  two  apparently 
normal. 

Cases  E  and  F. — H.  and  M.  Males ;  brothers,  aged  respectively 
10  and  8  years  at  time  photograph  was  taken.  Superficial  excitable 
idiots.  Brown  hair  and  eyes.  Sight,  hearing,  taste,  and  smell  nor- 
mal, so  far  as  can  be  judged.  Alveolar  arches  wider  than  normal, 
and  the  palates  almost  flat;  sialorrhoea.  Teeth  fair.  Right-handed. 
Circulation  poor ;  hands  and  feet  always  cold.  Began  to  walk  at  end 
of  first  year,  drag  feet,  but  are  very  active  children.  Are  uncon- 
scious of  danger,  excitable,  and  destructive ;  quick-tempered,  and 
when  angry  bite  fingers,  slap  faces,  and,  throwing  themselves  down, 
will  beat  heads  upon  the  floor.  Are  egotistical,  fond  of  attracting 
attention,  obstinate,  selfish,  and  jealous.  Powers  of  attention,  imita- 
tion, and  memory  rather  remarkable  for  children  of  this  grade. 
Nervous  and  in  perpetual  motion ;  unclean  in  habits,  incapable  of 
self-help.    Heads  microbrachycephalic. 


Plate  L. 


Case   B. 
EPILEPSY— PETIT   MAL. 


MICROCEPHALUS.  299 

H. — Height,  4  feet  3  inches ;  weight  52  pounds. 

Head  Measurements.  inches. 

Circumference   i6y2 

Naso-occipital  arc  op/% 

Binauricular  arc  10^5 

Antero-posterior  diameter 5^2 

Greatest  transverse  diameter 4^ 

Binauricular   diameter    4% 

Facial    length    5J/2 

Cephalic  index   79 

Craniectomy  was  performed  in  his  fifth  year,  the  incision  being 
made  through  the  skull  in  an  antero-posterior  diameter,  beginning  at 
the  occipital  crest  and  coming  forward  to  the  root  of  the  hair. 

A  mute  when  he  entered  school  at  six  years  of  age,  has  learned  to 
make  his  wants  known  in  single  words  and  short  phrases.  Was  wild 
and  unmanageable,  but  responding  to  discipline,  is  now  fairly 
obedient  to  simple  commands.  Has  learned  to  hold  chalk,  and  pencil, 
and  to  erase  black-board,  to  string  beads  and  match  primary  colors, 
to  lace  a  shoe,  and  to  recognize  pictures,  such  as  horse,  cow,  dog,  etc., 
associating  and  calling  name,  when  he  sees  the  living  animal. 
Can  execute  a  few  simple  movements  in  drill  and  march  a  little. 
Recognizes  members  of  his  family  when  seeing  them  after  long 
intervals ;  is  fond  of  his  brother,  of  his  nurses  and  of  animals.  Is 
much  diverted  by  music,  which  always  excites  him  to  rhythmic 
movements. 

M. — Height,  4  feet  1  inch;  weight,  46%  pounds. 

Head  Measurements.  inches. 

Circumference   15^ 

Naso-occipital  arc  oP/% 

Binauricular  arc 9^4 

Antero-posterior  diameter    4^4 

Greatest  transverse  diameter 4^2 

Binauricular    diameter 4^ 

Facial  length  5-Ms 

Cephalic  index   96 

Craniectomy  was  performed  in  his  third  year,  an  incision  having 
been  made  through  the  skull  in  an  antero-posterior  direction,  begin- 
ning at  the  occipital  crest  and  coming  forward  to  the  root  of  the 
hair,  then  curving  to  the  right,  a  piece  of  bone  one  inch  wide  being 
removed. 

Body  well  formed,  hands  abnormally  large.  Has  excessive  muscu- 
lar development,  especially  at  wrists,  enabling  him  to  lift  himself  by 
hands  and  to  cling  to  a  pole.  If  his  hands  are  supported,  will  climb 
with  wonderful  agility  and  peculiar  monkey-like  movements.     Ner- 


300  ILLUSTRATIVE    CASES. 

vous  and  active.     He  never  walks,  but  runs  in  a  peculiar  "  tip-toe  " 
fashion.    Vocabulary  limited  to  a  very  few  words. 

Devoted  to  his  brother,  is  fond  of  other  children,  but  mischievous, 
likes  to  tantalize  them,  which  he  does  in  a  variety  of  ways.  Will 
strike  in  jest,  unconscious  of  the  violence  of  a  blow.  Can  call  his 
brother  and  nurses  by  name,  say  "  good-bye,"  kissing  and  waving 
his  hand,  but  attempts  nothing  further  than  the  two  short  phrases : 
"  I'll  kill  you,"  and  "  What's  that?" 

More  mischievous  and  destructive,  with  less  powers  of  attention 
than  his  brother,  M.  has  never  been  a  fit  subject  for  school  training. 
Is  a  good  mimic.  Imitates  the  barber  stropping  razor,  lathering 
face  and  shaving.  Can  fall  and  imitate  a  spasm  perfectly,  and 
enjoys  the  fun  of  it  with  his  playmates,  but  when  a  boy  falls  in  a 
true  spasm,  will  run  quickly  to  place  a  pillow  under  his  head.  Has 
learned  to  "  back-fold  "  his  arms,  and  understands  that  when  he  is 
turned  face  to  the  wall,  placed  in  a  corner,  or  forced  to  stand  on 
a  stool  that  it  is  for  discipline.  Knows  the  name  of  every  boy  in 
his  dormitory — 34  in  all — and  can  also  select  a  particular  key  from  a 
large  bunch. 

Family  history  good ;  it  is  claimed  that  there  is  no  nervousness  on 
either  side.  Both  boys  were  born  at  full  term ;  labor  in  each  case 
extremely  difficult  but  without  the  aid  of  instruments.  Father,  a 
merchant  by  occupation,  24,  and  mother  28,  at  time  of  H.'s  birth ; 
M.  born  two  years  later.  Both  children  nourished  by  mother.  Both 
heads  were  observed  at  birth  to  be  unusually  small ;  the  fontanels 
had  closed,  and  there  was  bulging  of  the  cranial  vault,  extending  in 
antero-posterior  direction. 

A  constant  source  of  interest  to  those  in  charge,  both  have  re- 
ceived for  over  six  years  more  than  the  usual  amount  of  individual 
attention,  yet  the  result  attained  has  not  been  even  capacity  for  self- 
help  without  assistance.  These  cases  offer  therefore  still  another 
practical  refutation  of  the  claims  made  by  the  advocates  of  craniec- 
tomy. This  refutation  is  further  emphasized  by  a  comparison  be- 
tween these  cases,  and  the  second  one  described  under  microcephalus 
(Case  B,  p.  296).  Of  the  same  age  as  the  older  of  these  brothers  and 
possessing  practically  the  same  mental  capacity,  with  head  measure- 
ments closely  approximating,  P.  who  has  received  the  same  care  and 
training  for  about  the  same  length  of  time — the  three  boys  having 
grown  up  together — is  really  both  physically  and  mentally  rather  in 
advance  of  the  other  two  boys  who  have  had  the  advantage  (?)  of 
craniectomy. 

Hydrocephalus. 

Case  A. — C.  E.  Male;  idio-imbecile,  aged  31  years,  came  to  me 
at  18.     Height  5  feet  2  inches;  weight  134^2  pounds. 


IDIOTS   SAVANTS.  3OI 

Head  Measurements.  inches. 

Circumference  2714 

Naso-occipital  arc   171^ 

Binauricular  arc  1754 

Antero-posterior  diameter 8% 

Greatest  transverse  diameter 8 

Binauricular  diameter 6y2 

Facial    length    yy2 

Cephalic    index 92.34 

Skin  very  white,  eyes  blue,  large  nose,  and  defective  teeth.  Walks 
with  difficulty*  footsteps  weak  and  tottering.  Has  a  fair  vocabulary; 
talks  incessantly,  but  in  childish  fashion.  Has  a  good  memory; 
repeats  nursery  rhymes,  and  imagines  he  can  read,  but  really  knows 
only  a  few  letters  of  the  alphabet,  having  been  tried  in  school  for 
three  years  with  no  result.  Learned  to  care  for  a  helpless  child,  and 
to  polish  floors,  but  seven  years  after  admission,  began  to  grow  more 
helpless  and  retrogression  was  marked. 

Father,  a  machinist  by  trade,  36,  and  mother  30,  at  time  of  C.'s 
birth.  Maternal  uncle  insane.  Eighth  child  ;  born  at  full  term ;  labor 
ordinary ;  apparently  strong  and  healthy  until  sixth  month,  when  he 
began  to  fail  and  head  began  to  enlarge. 

Case  B. — H.  H.  Male;  idio-imbecile,  epileptic,  17  years  old. 
Came  to  me  at  13,  when  mental  limit  had  almost  been  reached. 
Height  4  feet  7%  inches ;  weight  89  pounds. 

Head  Measurements.  inches. 

Circumference     25 

Naso-occipital   arc 1634 

Binauricular  arc  *7ZA 

Antero-posterior  diameter 8^2 

Greatest  transverse  diameter jA 

Binauricular   diameter    51^ 

Facial  length  6TA 

Cephalic  index   86 

Fair  complexion ;  eyesight  somewhat  defective,  hearing  and  speech 
perfect,  but  limited  vocabulary.  Cleanly  in  habits,  but  needing  care 
in  self-help.  Powers  of  imitation  and  memory  good,  but  had  been 
much  neglected.  Learned  to  do  simple  house-work,  and  after  eight 
months'  persistent  effort,  to  braid  rope  in  three  strands,  and  to  wash 
and  dress  himself. 

Father  a  stone  mason,  drank  to  excess  as  did  also  paternal  grand- 
father. Mother's  sister  feeble-minded.  Birth  ordinary;  nourished 
by  mother. 

Idiots  Savants. 

Case  A. — K.  W.  Specialty  drawing.  Male ;  high-grade ;  22  years 
old ;  an  epileptic,  with  attacks  occurring  at  long  intervals.  Eyesight 
very  defective ;  other  senses  normal.     Good  bearing  and  attractive 


302  ILLUSTRATIVE    CASES. 

personality.  An  excellent  musician — above  the  average — he  is  also 
most  ready  with  his  pencil  and  a  wonderful  caricaturist.  Seeing  the 
numorous  side  of  everything,  is  quick  to  catch  likenesses  and  pecu- 
liarities, and  to  note  their  association,  and  is  equally  quick  in  repro- 
ducing them. 

On  one  occasion  in  a  class  exhibit  before  an  educational  associa- 
tion, drawing  with  his  usual  facility,  some  pigs  feeding,  interrogated 
as  to  his  subject,  he  replied  without  hesitation  and  without  inter- 
rupting his  work :  "  Pork  and  beans."  Once  I  wanted  him  to  design 
some  original  menu  cards  for  a  dinner  party.  He  tried  persistently 
for  two  days,  but  found  no  ideas  that  would  materialize.  Finally 
his  teacher  taking  him  to  my  library,  showed  him  some  steins  and 
loving  cups.  He  at  once  seized  the  idea,  and  sitting  down,  drew 
off-hand  a  wonderfully  clever  set  of  cards — rabbits,  dogs,  and  pigs. 
One  especially  unique,  represented  a  rabbit  hilariously  kicking  the 
bottom  out  of  a  loving  cup  as  he  passed  it.  Learning  that  one  of  the 
expected  guests  had  been  a  Heidelberg  student  and  a  duelist,  he 
pictured  for  him  two  rabbits  fencing.  "  Study  hour  in  High  Grade 
A,"  was  the  title  of  a  rough  sketch  in  which  he  showed  the  desks  of 
his  class-room,  each  seat  filled  by  an  animal,  possessing  some  pecu- 
liarity of  its  occupant.  Thus :  a  boy  slow  and  stubborn,  is  portrayed 
as  a  mule ;  another,  surly,  is  a  bear ;  another  is  a  monkey,  "  because  he 
is  funny  and  cuts  up  " ;  a  goose  is  a  silly  boy ;  a  pig,  a  greedy  one, 
and  a  fox  is  one  who  is  very  sly.  A  girl,  who  is  clever,  is  repre- 
sented as  an  owl,  and  a  boy,  constantly  crowing  over  his  own  achieve- 
ments, as  a  rooster,  etc.  He  himself  having  a  peculiar  walk  appears 
as  a  lobster,  "  because  a  lobster  walks  kind  of  lop-sided,"  and  the 
teacher,  who  was  rather  above  medium  height,  as  a  giraffe.  (Vide 
illustration.)  The  members  of  his  band  often  figure  in  a  variety  of 
characters  and  called  upon  at  the  different  seasons  to  contribute  deco- 
ration for  gifts,  he  will  draw  as  rapidly  as  the  suggestions  are  given. 

But  little  is  known  of  family  history,  except  that  mother  died  of 
phthisis. 

Case  B. — X.  K.  Specialty,  music.  Boy;  high-grade;  17  years 
old.  Pleasing  address  and  courteous  manners.  Has  a  wonderful 
talent  for  music ;  plays  equally  well  on  piano  and  pipe-organ,  either 
at  sight  or  by  memory,  and  improvises  and  composes  without  effort. 
Has  had  the  benefit  of  a  course  in  music  at  a  European  conservatory. 
Is  an  apt  translator  of  foreign  languages.  Has  wonderful  hand- 
skill,  which  he  is  capable  of  utilizing,  as  purpose  of  the  moment 
demands.  Is  an  excellent  type-writer  and  accurate  above  the 
average.  From  his  tenth  year,  he  had  attended  various  schools  with- 
out receiving  the  discipline  which  his  needs  required. 

Case  C. — L.  W.     Specialty,  hand  weaving.     Male ;  29  years  old ; 


IDIOTS    SAVANTS.  303 

idio-imbecile.  A  mute ;  other  senses  normal.  Understands  every- 
thing that  is  said  to  him,  and  makes  peculiar  grunting  noises  in  his 
efforts  for  speech.  Could  not  learn  to  read  and  write,  but  is  very- 
deft  with  his  fingers,  weaving  very  rapidly  intricate  patterns,  with 
colored  worsteds. 

Second  child ;  born  at  full  term ;  nourished  by  mother,  was  appar- 
ently healthy  until  one  year  old,  when  spasms  developed,  of  which, 
however,  there  has  been  no  recurrence.  Father  a  farmer,  slow  of 
speech  and  action,  was  37,  and  mother,  who  has  a  small  goitre,  was 
28  at  time  of  child's  birth.     Both  parents  mentally  below  par. 

Case  D. — J.  I.  Specialty,  lightning  calculation.  Boy;  high-grade; 
15  years  old ;  epileptic,  spasms  recurring  monthly.  Can  read  and  write, 
and  is  fond  of  music  and  animals.  A  mathematical  phenomenon ; 
has  wonderful  facility  with  numbers.  Can  multiply,  divide,  add, 
and  subtract  as  rapidly  as  numbers  are  called.  When  fatigued,  or 
for  several  hours  succeeding  a  spasm  he  does  this  very  slowly,  or  not 
at  all,  but  when  fresh  and  in  good  condition,  can  calculate  very  rap- 
idly, giving  results  almost  simultaneous  with  the  speaker's  voice. 

Born  at  full  term ;  labor  ordinary. 

Case  E. — A.  E.  Specialty,  music.  Male ;  idio-imbecile ;  epileptic, 
30  years  old.  A  dwarf ;  height  4  feet  i*/£  inches  ;  weight  66l/2  pounds. 
Physiologic  age  about  60 ;  psychologic  age  10  years — a  young  man 
with  an  old  body  and  a  childish  mind. 

Vocabulary  and  understanding  very  limited,  but  has  a  wonderful 
ear  for  music.  Can  catch  any  tune  he  has  heard  once,  reproducing  it 
accurately  on  the  mouth  organ.  Can  pick  out  tunes  on  a  toy  piano, 
and  enjoying  his  own  performances  immensely,  will  applaud  himself 
vociferously,  clapping  his  hands  and  shouting  with  glee.  Could 
never  learn  to  read  or  write,  and  is  unable  even  to  dress  himself. 
Spasms  occur  not  oftener  than  once  a  year,  but  are  very  severe. 

Born  at  full  term ;  ordinary  labor.  A  crying  infant,  was  dosed 
largely  with  so-called  "  soothing  syrups."  Had  meningitis  and  did 
not  walk  until  sixth  year.  Father,  a  day  laborer,  probably  syphilitic ; 
mother  scrofulous  and  subject  to  "  sick  headaches."  Both  grand- 
fathers were  drunkards.  Paternal  grandmother  and  father  had  each 
a  sister  feeble-minded. 

Case  F. — W.  L.  Specialty,  music.  Boy;  idio-imbecile;  13  years 
old.  A  musical  prodigy.  Semi-mute;  speech  limited  to  two  or 
three  words.  A  fair  trial  in  kindergarten  for  four  years  enabled  him 
only  to  distinguish  colors,  but  with  a  wonderfully  quick  ear  for  music, 
learned  readily  to  hum  all  the  songs.  Can  catch  any  tune  he  hears 
and  reproduce  it  accurately,  humming  with  eyes  closed  and  a 
rhythmical  swaying  of  the  body  to  and  fro.  With  keen  appreciation 
of  time,  he  can  distinguish  march,  waltz,  polka,  etc.,  beating  time 


3O4  ILLUSTRATIVE    CASES. 

with  hands  and  changing  readily  with  change  of  music.  Asking 
him  on  one  occasion  for  a  song  he  had  not  heard  for  several  years,  he 
had  some  little  difficulty  in  recalling  a  certain  strain,  and  hummed  it 
over  and  over,  until  he  at  last  succeeded,  and  then  he  hummed  it 
through  without  hesitation.  He  in  this  way  reproduced  with  mar- 
vellous accuracy  the  principal  airs  of  a  light  opera,  which  he  had 
heard  but  once. 

This  case  is  illustrated  and  further  described,  under  the  head  of 
Adenoma  Sebaceum,  Chapter  XIII.,  Case  3. 

Case  G. — C.  L.  Specialty,  music.  Male ;  high-grade ;  almost  24 
years  old  when  photograph  was  taken.  Came  to  us  in  eleventh  year ; 
was  of  average  height  and  weight,  but  very  childish  for  his  years. 
Sight  very  defective,  but  other  senses  normal.  Walked  like  an  old 
person,  with  body  inclined  forward  and  step  without  elasticity. 
Could  read,  write  and  cipher,  but  extremely  nervous ;  attention  was 
easily  diverted  from  anything  except  music,  which  was  his  passion, 
and  in  which  he  became  absolutely  absorbed.  Made  gradual  but 
steady  progress  during  seven  years  in  both  mental  and  manual  work. 
Accomplished  the  school  course  and  became  quite  a  good  carpenter. 
Always  devoted  to  music,  learned  to  play  the  cornet  readily,  com- 
posed quite  well,  arranging  his  pieces  for  the  band  unassisted. 

Manly,  thoughtful  and  quiet,  of  good  moral  tone,  he  was  a  leader 
among  the  boys  and  always  for  good.  After  leaving  us  he  went 
west  and  was  the  band  teacher  in  another  large  institution,  and  later 
became  the  leader  of  an  excellent  band  in  Chicago. 

Born  at  full  term;  ordinary  labor.  Sickly  in  early  childhood, 
did  not  walk  until  fourth  year.  Poorly  nourished,  living  in  condi- 
tion of  extremest  poverty ;  very  slow  in  developing  mentally. 
Father,  a  butcher  by  occupation,  was  a  drunkard  and  shot  himself ; 
mother,  abused  by  husband,  weak  and  nervous,  died  of  "  heart  dis- 
ease "  at  the  age  of  38,  after  having  borne  12  children.  All  weak, 
ill-nourished,  and  having  "  head  trouble,"  10  died  before  reaching 
the  second  year.    A  sister  who  survives  is  said  to  be  normal. 

Case  H. — J.  O.  Memory  and  mimicry.  Boy ;  low-grade  moral 
imbecile.  Hydrocephalic ;  epileptic ;  16  years  old  when  photograph 
was  taken.  A  dwarf ;  height  4  feet.  Admitted  to  Training  School 
in  fourteenth  year.  Hands  extremely  small,  speech  perfect  and  large 
vocabulary.  Vulgar  and  profane  beyond  description.  Could  distin- 
guish between  right  and  wrong,  but  chose  always  the  wrong.  Ego- 
tistic, would  do  almost  anything  to  attract  attention.  Had  a  fair 
voice  in  singing;  apparently  learned  to  read  and  write,  although  a 
great  deal  of  it  was  simply  memorizing  and  imitating.  His  was  a 
most  unusual  example  of  abnormal  development  of  memory  over 
other  mental  powers — a  "  memory  prodigy  "  so  to  speak.     Mental 


INSANITY.  305 

limit  reached  in  his  sixteenth  year ;  but  old  in  iniquity,  impudent,  defi- 
ant, quarrelsome,  obstinate,  and  disobedient,  a  breeder  of  mischief 
and  a  disturbing  element  in  the  schools,  he  was  transferred  to  a  cus- 
todial building,  where  under  closer  care  and  supervision  he  did  very 
well  for  the  remaining  4  years  of  his  life.  His  previous  history  would 
have  furnished  material  for  the  pen  of  a  Zola.  Condition  congenital ; 
the  unusual  size  of  his  head  was  noticeable  in  his  earliest  infancy ;  in 
his  fourth  year  it  began  to  increase  rapidly,  and  at  6  years  of  age  he 
wore  a  7^2  hat.  At  this  period,  having  attained  the  height  of  4  feet, 
he  ceased  to  grow,  but  developed  wonderful  power  of  memory,  re- 
peating songs,  poems  and  long  passages  by  rote,  with  an  aptitude 
truly  extraordinary.  With  quick  perception  was  united  a  strong  love 
of  metaphor,  making  him  peculiarly  susceptible  to  the  charm  of 
rhythm  in  music  and  poetry.  He  learned  to  recite,  without  effort, 
whole  pages  of  Milton  and  Shakespere,  and  to  sing  hymns  and  senti- 
mental songs.  Frequenting  the  theatres,  he  would  on  returning 
render  with  marked  precision  attractive  scenes  in  the  plays,  taking 
the  various  roles  of  the  actors  and  actresses  that  had  most  impressed 
him.  Lacking  the  care  and  guardianship  so  necessary  to  an  irrespon- 
sible, this  unfortunate  child — tiny  and  deformed,  a  travesty  of 
humanity — roamed  the  streets  at  will,  a  veritable  montebank. 

Naturally  he  soon  fell  into  evil  courses,  and  became  the  victim 
of  the  vicious.  Profanity  and  slang,  easy  for  him  to  acquire,  vulgar  al- 
lusions, a  double  entendre — cleverly  picked  up  here  and  there — made 
him  an  unfailing  source  of  amusement  to  a  class  of  men  who,  applaud- 
ing him  vociferously,  gave  him  whiskey  and  tobacco  as  a  reward 
for  his  performances,  and  encouraged  in  every  way  his  development 
in  the  school  of  vice.  With  astonishing  alacrity  he  learned  to  smoke, 
chew,  swear,  and  drink,  and  his  companions  were  corner-loungers 
and  the  scum  of  society.  Day  after  day  he  would  be  seen  staggering, 
intoxicated,  from  saloon  to  saloon.  A  woman  could  not  pass  him 
without  being  insulted.  The  newspapers  wrote  up  his  career  in  the 
most  sensational  manner.  Finally  after  8  years,  self-willed  and 
incorrigible,  this  "  enfant  prodigue "  became  a  veritable  "  enfant 
terrible  "  and,  a  nuisance  to  society  the  safety  of  his  community  de- 
manded his  permanent  sequestration.  He  died  in  his  twentieth  year 
of  softening  of  the  brain. 

Father  a  carpenter,  34,  and  mother,  21  years  old  at  time  of  his 
birth.  Ordinary  labor,  but  deficient  animation ;  nourished  by 
mother.     Parents  extremely  poor. 

Insanity. 

Case  A. — N.  N.  Recurrent  mania;  boy,  low-grade,  aged  12  years 
when  photograph  was  taken.    Came  under  my  care  at  6  years  of  age. 


306  ILLUSTRATIVE   CASES. 

Limited  vocabulary ;  speech  nervous,  spasmodic,  and  unintelligent. 
Obstinate  and  passionate ;  unclean  day  and  night,  unable  to  care  for 
himself.  Recognized  color  and  form,  knew  a  few  letters  of  the 
alphabet  and  could  sing  simple  songs.  Powers  of  imitation  and 
memory  good,  but  was  incapable  of  concentrating  attention.  Was 
given  a  trial  in  kindergarten  with  no  result.  Quiet  at  rare  intervals, 
when  amused,  would  suddenly,  as  attacks  came  on,  strike  and  bite 
other  children  without  the  slightest  warning  or  provocation,  running 
wildly  to  and  fro,  screaming,  overturning  and  mutilating  furniture, 
tearing  and  discarding  clothing,  and  climbing  recklessly  in  the  most 
dangerous  places.  During  lucid  intervals  was  much  exhausted. 
Attacks  increasing  in  frequency  and  violence,  he  was  transferred  to 
an  insane  hospital  in  his  eighteenth  year. 

First-born,  premature  birth ;  labor  difficult,  with  instruments ; 
nourished  by  mother.  Apparently  normal  until  15  months  old,  when 
he  had  several  falls  striking  his  head,  and  at  19  months  a  severe 
illness,  after  which  became  extremely  nervous  and  excitable.  Pa- 
rents first  cousins,  were  both  extremely  nervous.  Father  33,  and 
mother  34,  at  time  of  child's  birth.  History  of  phthisis  and  insanity 
in  both  families. 

Case  B. — W.  D.  Recurrent  mania.  High-grade,  boy;  10  years 
old.  Well-formed,  clear  rosy  complexion,  dark  brown  hair,  and  blue 
eyes.  Has  been  at  school  since  his  sixth  year.  Can  read,  write, 
cipher,  and  knit,  but  powers  of  attention  and  imitation  poor ;  is  slow 
and  backward.  Speech  perfect,  excellent  memory  and  vocabulary. 
Is  obstinate,  passionate,  disobedient,  and  seems  destitute  of  natural 
affection.  Is  fond  of  sitting  apart,  making  grimaces,  casting  furtive 
glances  and  muttering  to  himself :  "  Fiend  incarnate,"  "  I  am  a  per- 
fect Turk,"  "  Dirty  pig,"  "  Look  at  the  old  frog  sitting  in  the  corner," 
"  Fool,  fool,  fool." 

Music  affects  him  peculiarly ;  will  scream,  kick  and  cry  when  he 
hears  it,  although  at  times  will  sing.  Has  periodical  outbursts  of 
mania,  when,  while  sitting  quietly  talking  to  himself,  will  start  up 
suddenly  with  wild  eyes,  singing  snatches  of  songs,  beating  himself 
and  attacking  viciously  other  children.  For  long  periods  will  refuse 
food. 

Second  child ;  born  at  full  term ;  normal  labor,  nourished  by 
mother,  who  was  2j  and  father  32  at  time  of  child's  birth.  Has  one 
brother  considered  peculiar.  History  of  insanity  in  family  of  father, 
who,  a  monomaniac,  abandoned  wife  to  join  a  religious  community. 

Case  C. — M.  M.  Recurrent  mania.  Girl;  high-grade;  aged  13 
years.  Small  for  age ;  pleasing  features,  clear  complexion,  brown 
hair  and  eyes.  Choreic  movements  of  face.  Cleanly  in  habits. 
Powers  of  attention  poor,  but  memory  and  imitation  good.     Given 


INSANITY.  307 

to  mimicry.  Can  read,  write,  draw,  sing,  and  dance.  Is  affec- 
tionate. When  coming  to  school  at  8  years,  was  well  up  in  pri- 
mary work,  except  numbers  and  hand-training.  Given  special  drill 
in  these,  improved  for  2  years  when,  mental  limit  being  reached, 
became  erratic,  peculiar,  irritable  and  impatient  with  other  children, 
making  grimaces  and  disturbing  classes.  This  condition  rapidly 
increasing,  soon  merged  into  periods  of  violence,  and  she  became 
uncontrollable  and  cruel.  During  lucid  intervals  was  quiet  and 
obedient. 

Second  born ;  labor  difficult,  but  without  instruments.  Fed  arti- 
ficially. Father  32  and  mother,  who  is  very  deaf,  was  31,  at  time  of 
child's  birth.  Peculiarity  first  manifested  in  great  excitability  when 
child  was  3  years  old. 

Case  D. — L.  W.  Recurrent  mania.  Boy;  profound  excitable 
idiot,  epileptic,  18  years  old.  A  mute,  understanding  very  imper- 
fectly what  is  said  to  him.  Unclean  in  habits  and  incapable  of  self- 
help.  Choreic  movements  of  face.  Cannot  be  induced  to  take  meat 
or  milk.  During  attacks  of  mania,  which  occur  irregularly,  is  brutal 
and  cruel;  will  beat  himself,  bite  and  strike  other  children,  always 
discriminating  and  attacking  the  smaller  and  weaker  ones.  During 
lucid  intervals,  is  gentle  and  tractable.  Will  amuse  himself  by  the 
hour,  throwing  bits  of  chip  and  straw  high  in  the  air  and  jumping 
for  them.  As  attacks  increase  in  frequency  and  violence,  he  becomes 
more  dangerous. 

Second  child,  born  at  full  term ;  labor  normal ;  fed  artificially ; 
father  31  and  mother  26  at  time  of  child's  birth.  'Mother  much 
troubled  during  pregnancy  by  illness  of  father.  Spasms  occurred 
at  seventh  month  and  continued  through  second  year. 

Case  E. — R.  H.  "  Folie  Circulaire  "  or  circular  insanity.  Boy ; 
profound  excitable  idiot;  dwarf,  aged  15  years.  Came  to  me  in  his 
twelfth  year.  Fair  complexion,  rather  pleasing  features;  internal 
strabismus  of  right  eye,  and  marked  nystagmus  of  both.  A  mute, 
hearing  perfect,  understanding  very  simple  language ;  unclean,  help- 
less and  devoid  of  natural  affection,  even  for  his  mother  whom  he 
recognized,  but  to  whom  he  was  indifferent.  The  period  of  exalta- 
tion lasted  from  several  days  to  2  weeks ;  during  this,  the  boy,  wildly 
excited,  with  glaring  eyes  and  screaming  violently,  would  beat  un- 
ceasingly the  center  of  forehead  and  left  ear — never  the  right — caus- 
ing bruises  and  running  sores.  This  would  be  followed  by  a  period 
of  extreme  depression,  lasting  from  2  days  to  a  week — never  longer 
— during  which  he  liked  to  have  his  head  covered  with  a  handker- 
chief, and  would  sit  quiet  with  eyes  cast  down.  Out  of  this  he 
passed  into  the  nervous  stage — his  lucid  interval — during  which,  rest- 
less,  noisy,   moving   body   to   and   fro,   making   hissing,   grunting 


308  ILLUSTRATIVE   CASES. 

noises,  he  would  sit  continually  playing  with  strap  or  string,  winding 
and  twisting  them  around  his  nervous  hands.  This  also  lasted  for 
about  a  week,  when  the  circle  would  begin  again.  Died  of  phthisis 
in  fifteenth  year. 

Third  child  born;  instrumental  delivery.     Father  29,   mother — 
hysterical  and  excitable — 25  at  time  of  child's  birth. 


Plate  LI. 


EPILEPSY  — JACKSONIAN   OR    FOCAL. 


CHAPTER   XIX. 

illustrative  cases    (concluded) . 

Epilepsy  :    Grand  Mal  ;  Petit  Mal  ;  Jacksonian  or  Focal 
Epilepsy;  Psychic  Epilepsy. 

Grand  Mal. 

Case  A. — B.  L.  Boy;  high-grade  moral  imbecile,  aged  15  years, 
came  to  us  at  13.  Light  brown  hair,  and  blue  eyes,  with  a  winning 
smile  and  an  engaging  personality.  Vulgar,  passionate,  untruthful, 
and  dishonest ;  delighting  to  play  with  fire  and  in  tantalizing  children. 
Self-willed  and  persistent  to  a  degree,  in  accomplishing  a  purpose 
upon  which  he  has  once  set  his  mind,  but  absolutely  unstable  in  aim, 
wanders  from  one  thing  to  another,  and  although  possessing  fair 
ability,  brings  no  work  to  any  kind  of  perfection  and  will  never  suc- 
ceed. Is  fond  of  pouring  over  dictionaries  and  encyclopaedias,  and 
has  quite  a  fund  of  general  knowledge. 

Spasms  began  apparently  without  cause,  when  he  was  9  years 
old,  and  continued  at  irregular  intervals,  increasing  in  violence  and 
frequency,  until  thirteenth  year  when  they  yielded  to  treatment,  and 
for  a  period  of  10  months  there  was  entire  cessation.  Has  now  an 
occasional  convulsion. 

First  born;  full  term;  ordinary  labor;  nourished  by  mother,  who 
was  very  nervous  during  gestation.  Father  23,  and  mother  20,  at 
the  time  of  child's  birth. 

Case  B. — L.  J.  Boy;  high-grade,  aged  14  years.  Came  to  us  at 
11  years,  when  photograph  was  taken.  Black  hair  and  eyes,  sight 
and  hearing  perfect.  Childish  for  his  age  but  bright  and  under 
special  training  has  made  excellent  progress.  Fond  of  boys'  plays, 
but  nervous,  restless,  and  very  irritable.  Inherits  deftness  in  hand- 
work from  his  father,  and  did  beautiful  work  in  sloyd. 

Spasms  began  without  warning  in  tenth  year,  and  have  continued 
at  intervals  of  9  months,  but  their  violence  has  been  modified  by 
treatment. 

Parents  Jews,  refugees  from  Russia,  two  weeks  after  marriage; 
the  mother  suffered  great  anxiety  during  gestation.  First  born; 
ordinary  labor ;  nourished  by  mother.  Father  23,  and  mother  27,  at 
the  time  of  L.'s  birth.  Father  and  his  entire  family  are  goitrous. 
Another  son  is  feeble-minded. 

309 


3IO  ILLUSTRATIVE    CASES. 

Case  C. — P.  M.  Male ;  low-grade ;  32  years  old.  Red  hair,  gray 
eyes,  sight  and  articulation  poor,  but  hearing  and  vocabulary  fair. 
Sialorrhcea  marked.  Neat  in  dress,  is  capable  of  self-help  and  sim- 
ple housework.     Spasms  frequent  and  severe. 

First-born ;  full  term ;  ordinary  labor.  Was  a  "  blue  baby." 
Father  26,  and  mother  16,  at  time  of  P.'s  birth.  Father's  sister 
insane. 

Case  D. — A.  H.  Boy;  middle-grade;  10  years  old.  Pleasant  face, 
brown  hair  and  eyes,  excellent  vocabulary,  correct  enunciation,  and  is 
fond  of  music  and  of  animals ;  recognizes  color,  form,  and  numbers ; 
can  read,  write,  and  sing.  Can  care  for  himself  in  every  way  and 
aid  in  simple  housework.  Is  cleanly  in  habits,  but  irritable,  and  dis- 
obedient. Child  developed  epilepsy  when  3  years  old.  Spasms  very 
severe;  status  epilepticus  frequent. 

Second  child;  difficult  labor.  Father  30,  and  mother  24,  at  time 
of  A.'s  birth.  Father  syphilitic  and  a  drunkard ;  mother,  an  epileptic, 
died  of  cancer.  Maternal  grandfather  was  a  drunkard  and  paternal 
grandfather  died  of  phthisis. 

Case  E. — W.  Ff.  Boy;  idio-imbecile,  12  years  old.  Came  under 
my  care  at  6.  A  graceful,  pretty  child,  with  brown  hair  and  eyes. 
Could  speak  only  a  few  words  voluntarily,  but  articulation  fair  in 
repeating  what  is  said  to  him.  Careless  in  dress,  could  only  partially 
help  himself ;  occasionally  unclean.  Could  sing,  but  knew  nothing  of 
color  or  form.  In  improvement  class,  became  less  wild  and  erratic 
and  more  obedient.  Learned  to  do  a  little  knitting.  Spasms  frequent 
and  severe,  usually  preceded  by  a  period  of  nervous  excitement,  when 
he  will  divest  himself  of  his  clothing  and  run  around  the  room  in  a 
state  of  nudity. 

Fourth  born ;  full  term ;  partially  nourished  by  mother.  Was 
healthy  until  second  year,  when  epilepsy  developed. 

Case  F. — L.  S.  Male ;  middle-grade,  27  years  old.  Entered  insti- 
tution at  10  years  of  age.  Learned  to  read  and  write  quite  well,  and 
made  marked  improvement  in  hand-work,  becoming  an  efficient  aid 
in  household  service,  although  spasms — which  developed  in  second 
year — are  frequent  and  severe. 

Eighth  child ;  born  at  full  term ;  ordinary  labor ;  nourished  by 
mother,  who  suffered  great  anxiety  during  gestation.  Father  47, 
mother  42,  at  time  of  L.'s  birth.  Maternal  grandmother  died  of 
phthisis.     One  brother  had  goitre. 

Petit  Mal. 

Case  A. — G.  H.  Boy;  high-grade;  aged  14  years.  Came  to  us 
at  10  years.     Pleasant  expression,  blue  eyes  and  light  hair ;  cleanly 


JACKSONIAN    OR    FOCAL   EPILEPSY.  3  I  I 

in  habits.  Can  read  and  write,  recognize  color  and  form.  Powers 
of  attention,  imitation,  and  memory  good.  Has  a  violent  temper, 
and  will  bite  other  children. 

The  attack  is  characterized  by  sudden  paling  and  flushing, 
crossing  and  throwing  up  of  the  arms.  The  mental  faculties  are 
momentarily  disturbed  without  loss  of  consciousness.  At  first  recur- 
ring daily,  treatment  has  modified  these  attacks  to  about  10  a  month. 

Sixth  child ;  ordinary  labor.  Father,  a  painter,  40,  and  mother  32 
at  time  of  H.'s  birth.  There  is  a  record  of  a  fall  when  one  and  a 
half  years  old. 

Case  B. — T.  J.  Male ;  middle-grade ;  23  years  of  age.  Came  to 
us  at  15  years,  when  photograph  was  taken.  Rather  dull  expres- 
sion, pale  complexion,  brown  hair  and  eyes.  Learned  to  read  and 
write,  but  his  medium  of  development  has  been  chiefly  through  the 
hands.  Is  deft  at  any  kind  of  manual  work ;  has  been  in  shoe-shop 
for  a  number  of  years,  and  makes  a  very  good  shoe ;  can  mend  clocks 
and  umbrellas  and  has  been  quite  successful  in  attempts  at  wood 
carving.  During  attacks,  which  last  but  a  few  moments,  grows  sud- 
denly pale  and  occasionally  is  convulsed,  but  without  loss  of  con- 
sciousness. Attacks  modified  by  treatment,  occur  only  at  long  inter- 
vals; never  more  than  3  during  the  year. 

Second  child ;  ordinary  labor ;  nourished  by  mother.  Father,  an 
ignorant  laborer,  27,  and  mother  22,  at  time  of  J.'s  birth.  Father 
and  both  grandfathers  drunkards.  Paternal  grandfather  died  of 
phthisis. 

Jacksonian  or  Focal  Epilepsy. 

Case  A. — D.  F.  Boy;  middle  grade,  14  years  old.  Came  under 
my  care  at  12  years  of  age.  Had  been  much  neglected.  Round 
head,  brown  hair,  blue  eyes,  perfect  speech,  good  teeth;  is  fond  of 
children,  recognizes  colors,  knows  the  alphabet,  can  sing,  wash, 
dress,  and  care  for  himself  in  every  way.  Powers  of  attention, 
imitation,  and  memory  very  poor.  At  times  is  vulgar  and  profane, 
but  as  a  rule  is  well-mannered.  When  8  years  old,  he  suddenly 
without  any  apparent  exciting  cause  developed  epilepsy. 

His  is  a  case  of  idiopathic  epilepsy  of  the  Jacksonian  type.  The 
epileptogenetive  center  corresponds  with  and  is  limited  to  the  cor- 
tical area  for  the  right  hand  and  wrist.  The  "  signal  symptom,"  or 
aura,  is  experienced  several  minutes  before  the  attack  begins. 
Patient  says  that,  before  he  came  to  me,  when  he  was  attending 
public  school,  he  was  able,  after  experiencing  this  aura,  to  leave  the 
class-room  and  run  across  the  street  to  his  home  before  the  onset  of 
the  seizure.  The  aura,  as  he  describes  it,  "  feels  like  ants  crawling 
over  my  hand  "  (formication).     The  attack  begins  with  clonic  move- 


312  ILLUSTRATIVE    CASES. 

ments  of  the  fingers  and  thumb,  then  of  the  wrist  and  elbow ;  these 
lasting  half  a  minute  or  more.  Consciousness  is  retained  through- 
out, and  patient  watches  in  a  terrified  manner  the  involvement  of  the 
different  groups  of  muscles.  These  seizures  occur  as  often  as  once 
a  day,  unless  controlled  by  bromides. 

Born  at  full  term ;  difficult  labor.  Father,  by  trade  a  harness- 
maker,  aged  24,  and  mother  18,  at  time  of  child's  birth.  Mother, 
insane.     Paternal  grandmother  died  of  phthisis. 

Psychic  Epilepsy. 

Case  A. — H.  D.  Male;  middle  grade;  23  years  old.  Came  to  us 
when  14  years  old.  Head  well-formed,  brown  hair  and  eyes,  sight 
and  hearing  perfect,  excellent  vocabulary,  and  is  active,  noisy,  and 
at  times  obstinate.  Powers  of  attention,  imitation,  and  memory 
fair.  Does  excellent  work  in  school ;  can  read  and  write,  but  has 
attacks  of  nervous  excitement  followed  by  prolonged  periods  of 
automatism — sometimes  lasting  for  days — during  which,  uncon- 
scious of  what  he  is  doing,  he  simply  walks  as  in  a  dream ;  will  stand 
in  one  place  until  told  to  sit;  will  eat  when  commanded,  but  does 
nothing  of  his  own  volition.  For  the  time  being  he  is  a  veritable 
automaton,  but  when  the  attack  passes  he  is  again  bright  and  active. 
Very  deft  with  fingers,  he  is  quite  useful  in  the  carpenter  shop,  and 
in  domestic  work. 

Eighth  child;  nourished  by  mother.  Father,  a  drunkard — by 
trade  a  harness-maker — aged  44  and  mother  38,  at  time  of  H.'s  birth. 
Mother  was  at  one  time  insane.     H.  had  a  fall  during  infancy. 

Case  B. — W.  F.  Male;  middle  grade;  age  about  40.  A  vaga- 
bond; unable  to  read  and  write.  Alternating  from  emotional  to 
automatic  states ;  does  all  sorts  of  sensational  things,  after  which  he 
subsides  into  an  automaton,  doing  nothing  voluntarily,  guided  only 
by  the  will  of  another.  Thus,  on  one  occasion,  at  three  o'clock  in 
the  morning  he  ran  through  a  village  ringing  a  bell  and  shouting 
fire,  calling  the  people  and  warning  them  to  flee  for  their  lives. 
After  this  followed  a  period  of  depression,  lasting  several  weeks. 
Again,  he  wandered  through  his  native  town,  begging  for  money  to 
buy  "  a  hole  to  live  in."  Many,  who  did  not  understand,  regarding 
the  matter  as  a  joke,  gave  him  small  sums,  ranging  from  ten  cents 
to  one  dollar  and  very  soon  he  had  collected  money  sufficient,  and 
actually  bought  a  piece  of  ground,  containing  a  hole  in  which  the 
sewerage  of  the  town  emptied.  Then  he  borrowed  a  horse  and 
wagon  and  immediately  proceeded  to  fill  up  the  hole.  The  people 
of  the  community,  much  perplexed,  then  used  every  argument  with 
him,  but  he  remained  obdurate,  until  they  promised  him  a  house  and 
garden,  and  they  were  actually  compelled  to  subscribe  some  hun- 


Plate  LI  I. 


[    " 

.../, 

Si 

f*      ** 

TiLlL^/'  • 

■  ^^B 

■  Ik 

■ 

Case  B. 
EPILEPSY— PSYCHIC. 


PSYCHIC    EPILEPSY.  313 

dreds  of  dollars,  sufficient  to  purchase  him  quite  a  decent  residence. 
After  this,  during  one  of  his  periods  of  depression,  he  disappeared 
for  some  months — as  he  will  often  do,  when  in  this  state — and  after 
wandering  over  the  mountains  for  varying  periods  of  time,  will  sud- 
denly turn  up  in  the  most  unexpected  fashion. 

Case  C. — C.  H.  Female ;  low  grade ;  30  years  of  age.  A  deaf- 
mute  ;  made  no  progress  in  school,  except  learning  to  sew  and  knit. 
Emotional,  excitable,  has  screaming  spells,  often  of  several  weeks' 
duration  unconscious  of  what  she  is  doing,  followed  by  periods  of 
automatism  in  which  she  acts  only  under  the  will  of  another.  Will 
assume  any  position  and  maintain  it  until  otherwise  directed. 

She  has  one  imbecile  brother,  and  father  is  a  drunkard. 


CHAPTER   XX. 

THE    CASE    OF    SAMUEL     HENDERSON,     MURDERER.1      RESPONSIBLE    OR 

IRRESPONSIBLE? 

The  host  of  juvenile  offenders  filling  our  police  courts  and  the 
startling  accounts,  with  which  the  daily  papers  teem,  of  crimes  trace- 
able to  youth  of  tender  age,  is  attracting  the  interested  study  of 
criminologists,  and  drawing  many  thoughtful  minds  to  the  consid- 
eration of  cause  producing  such  effect,  and  to  careful  pondering 
upon  the  degree  of  responsibility  or  of  irresponsibility  of  this  class. 

The  trial  and  conviction  of  Samuel  Henderson,  aged  fifteen  years, 
of  the  murder  of  Percy  Lockyer,  aged  five,  makes  a  valuable  addi- 
tion to  the  annals  of  criminology  and  of  sociology,  as  showing  the 
possibility  of  crime  absolutely  motiveless,  beyond  the  momentary  im- 
pulse of  a  nerve  storm,  and  the  danger  to  society  of  an  uncontrolled 
irresponsible  element  in  its  midst.  The  extreme  youth  of  both  ap- 
peals to  one  not  less  than  does  the  sense  that  each  was,  in  a  meas- 
ure, the  victim  of  ignorance  and  of  circumstance. 

The  scene  of  the  tragedy  was  Glackin's  woods,  in  the  suburbs  of 
Philadelphia,  and  the  details  of  the  case  are  these :  On  the  after- 
noon of  Friday,  January  14,  1898,  Percy  Lockyer,  playing  in  an 
adjoining  yard  with  Willie  Addison,  the  son  of  a  neighbor,  wan- 
dered off  with  his  little  playfellow.  At  half-past  five,  the  parents 
sending  for  him,  were  alarmed  to  learn  that  both  children  had  been 
down  in  the  woods  with  a  boy  who  had  hidden  Percy's  clothing  in 
a  tree,  and  that  Willie  had  returned,  leaving  Percy  there.  Mr. 
Lockyer,  an  engineer  by  trade,  being  incapacitated  by  temporary 
lameness,  sent  his  older  son  with  a  friend  to  investigate.  They  re- 
turned with  no  definite  tidings,  and  the  family,  growing  most  anx- 
ious as  night  came  on,  determined  to  at  once  notify  the  police.  A 
young  girl,  Bridget  Foley,  overhearing  the  conversation  at  the  pa- 
trol box,  said  that  she  had  seen  Percy  Lockyer  and  Willie  Addison, 
at  about  two  o'clock,  talking  with  Samuel  Henderson  at  the  school- 
gate  ;  later  they  had  crossed  the  fields  in  the  direction  of  the  woods, 
Henderson — the  path  being  muddy — carrying  little  Percy  on  his 
shoulder,  and  that  between  four  and  five  o'clock  she  had  seen  Hen- 
derson returning  alone.  The  officer,  in  company  with  young  Lock- 
yer, went  immediately  to  the  Henderson  home  and  questioned  Sam- 

1  Reprinted  from  the  Alienist  and  Neurologist,  January,  1900. 

3H 


Plate  LIU. 


THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER.  3 1  5 

uel,  who  denied  the  story  in  toto,  saying  that  he  had  been  at  school 
all  that  afternoon.  His  manner,  however,  aroused  the  suspicions 
of  both,  and  Lockyer  reported  to  his  father  that  Sam  had  appeared 
to  hesitate,  as  if  he  knew  more  than  he  cared  to  tell. 

During  the  night  a  fruitless  search  was  made  through  Glackin's 
woods  by  sympathizing  friends  and  the  distracted  and  disabled 
father.  The  next  morning  Bridget  Foley,  carefully  interrogated, 
adhered  to  her  original  statement,  while  Henderson  was  equally 
vehement  in  disclaiming  any  knowledge  of,  or  even  an  acquaintance 
with,  Percy  Lockyer. 

Mr.  Lockyer,  the  afternoon  of  the  same  day,  went  again  to  the 
woods  with  a  police  sergeant  and  Willie  Addison,  hoping  to  locate 
the  tree  where  the  clothing  was  said  to  have  been  hidden.  This  the 
child  failed  to  do,  but  just  as  they  were  about  to  separate,  the  officer 
discovered,  lying  in  the  fork  of  a  tree,  a  coat  and  a  hat  that  the 
unhappy  father  recognized  at  once.  All  that  day  the  search  was 
continued  through  the  woods,  in  farm-houses,  and  in  the  neighbor- 
ing villages  without  result.  On  Sunday  morning,  January  16,  two 
police  officers,  again  going  over  Glackin's  woods,  at  Reddy's  Run 
noticed  a  bit  of  plaid  in  the  stream,  and  further  examination  re- 
vealed Percy's  body  lying  in  about  fourteen  inches  of  water.  It  lay 
face  down,  hands  extended,  left  leg  straight  and  the  right  bent,  with 
a  large  rock  on  the  right  hip  and  another  on  the  back  of  the  head. 
A  red  handkerchief,  tied  around  the  neck  with  a  double  knot  under 
the  left  ear,  was  tight  enough  to  have  impeded  circulation  without 
arresting  respiration.  Superficial  cuts,  lacerations,  and  contusions 
disfigured  the  face  and  hands.  There  was  a  stab  wound  on  the 
shoulder  and  one  under  the  fifth  rib,  penetrating  the  left  lung,  with 
some  signs  of  hemorrhage,  but  death  had  evidently  been  caused  by 
drowning. 

Samuel  Henderson,  when  later  confronted  by  Bridget  Foley,  still 
denied  having  been  with  the  children.  "  I  knew  you  by  your  cap 
and  coat,"  she  said.  "  I  did  not  have  this  coat  on,"  quickly  replied 
the  boy.  "  What  coat  did  you  have  on  ?  "  questioned  the  officer. 
"  My  light  one,"  he  answered.  "  Then  she  did  see  you  ?  "  "  Yes." 
In  response  to  closer  questioning  and  adroit  suggestions  he  went  on 
to  tell  (even  demonstrating)  how  Percy  had  fallen  from  a  tree  upon 
some  broken  sticks  and  branches,  how  he  had  afterward  run  down 
the  hill  in  the  direction  of  the  creek,  and  that  was  the  last  he  saw 
of  him.  Continuing  his  contradictions,  however,  he  gave  yet  an- 
other version,  and  averred  that  they  were  playing  "  Wild  West," 
saying :  "  I  was  sharpening  a  stick  at  the  foot  of  the  hill  with  a 
potato  knife,  and  as  Percy  ran  down,  it  stuck  in  his  heart,  and  the 
blood  came  squirting  out,  and  he  fell  on  his  back  and  didn't  speak  a 


3  l6  THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER. 

word  when  I  called  him."  He  acknowledged  that,  after  this,  becom- 
ing frightened,  he  put  the  body  in  the  creek,  first  mutilating  it  to 
prevent  recognition,  and  then  placing  stones  on  it  to  keep  it  down. 
On  this  confession  he  was  committed  to  the  Philadelphia  County 
Prison  to  await  trial. 

Being  called  as  an  expert  for  the  defense,  I  made  careful  exam- 
inations of  the  boy,  and  in  frequent  conversations  with  him  and  his 
parents  gathered  the  following  data:  Maternal  great-grandfather 
died  of  cancer  of  the  throat;  maternal  grandfather  and  his  two 
brothers  died  of  paralysis.  Paternal  grandfather  was  a  moderate 
drinker  and  received,  while  in  the  detective  service,  a  blow  on  the 
head  from  which  he  never  wholly  recovered ;  had  "  flighty  spells," 
was  erratic  and  peculiar,  and  died  during  a  paralytic  seizure. 
Mother's  nephew  is  an  epileptic,  and  two  cousins  died  of  phthisis. 
Samuel  and  his  parents  are  natives  of  Pennsylvania,  as  are  also  two 
other  children,  a  boy  and  a  girl,  aged  respectively  eight  and  fourteen 
years,  both  of  whom  are  said  to  be  mentally  defective.  The  mother 
keeps  a  small  variety-shop ;  the  father,  who  is  a  ventriloquist,  has 
a  Punch-and-Judy  show,  and  both  parents  have  at  various  times 
traveled  with  "  Buffalo  Bill." 

Father  decidedly  under  par  mentally.  Was  28  years  old,  and 
mother  18,  at  time  of  Sam's  birth.  Mother  possessed  of  an  attrac- 
tive personality,  is  intelligent  and  remarkably  well  educated  for  one 
of  her  class,  but  extremely  nervous,  and  has  been  a  sufferer  from 
trifacial  neuralgia  for  years.  Was  troubled  with  dropsy  prior  to 
the  birth  of  each  of  her  three  children,  of  whom  Samuel  was  the 
first-born.  During  the  sixth  month  of  gestation  she  was  ill  for  six 
weeks,  suffering  severely  from  gastric  disturbance.  The  child  Sam- 
uel was  born  at  full  term,  without  the  aid  of  instruments,  although 
the  labor  was  extremely  difficult  and  lasted  for  three  days ;  he  was 
what  is  known  as  a  "  blue  baby,"  and  had  a  caput  succedaneum. 
Nourished  by  mother,  he  was  healthy  until  the  sixth  month,  when 
an  attack  of  cholera  infantum  lasting  six  days  was  followed  by  an 
attack  of  meningitis  lasting  six  weeks,  during  which  time  ice  was 
kept  constantly  applied  to  his  head ;  he  lay  in  spasms  for  five  hours, 
with  form  rigid,  and  eyes  set;  apparently  dead,  preparations  were 
begun  for  his  funeral,  when  he  revived.  He  has  had  almost  every 
disease  known  to  childhood — measles,  whooping-cough,  varicella ; 
when  four  years  old,  during  a  severe  attacks  of  scarlet  fever,  he  was 
unconscious  for  a  long  time ;  later  he  had  two  attacks  of  typhoid 
fever — one  when  10,  the  other  when  13  years  of  age.  After  each 
illness  his  deterioration,  both  mental  and  physical,  was  such  as  to 
occasion  comment.  He  suffers  now  with  frequent  headaches.  With 
that  uncertain  memory  peculiar  to  imbeciles — phenomenally  accu- 


THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER.  317 

rate  in  some  respects,  absolutely  unreliable  in  others — he  memorized 
his  lessons  with  difficulty,  and  while  studying  would  frequently  beat 
his  head  and  say :  "  The  man  who  made  this  book  tried  to  confuse 
me.  Some  day  I  will  run  against  a  stone  and  bump  my  brains  out." 
He  reads  the  daily  papers  understandingly,  and  delights  in  dime 
novels,  in  the  adventures  of  Indians,  of  Jesse  James,  etc. 

He  recognizes  form  and  color,  discriminates  between  tints  and 
shades,  can  count  to  the  hundreds,  and  appreciates  numerical  values. 
Writes  fairly  well,  but  is  unable  to  draw ;  hands  not  being  properly 
trained,  he  cannot  drive  a  nail,  although  his  powers  of  attention  and 
imitation  are  good  and  he  has  learned  to  do  simple  housework.  His 
table  manners  are  fair — he  is  not  gluttonous,  masticates  properly, 
uses  both  knife  and  fork — and  he  can  wash,  dress,  and  care  for  him- 
self in  every  way.  Addicted  to  cinedia,  but  otherwise  his  personal 
habits  are  cleanly. 

Choreic  movements  of  the  face  betray  an  exceedingly  nervous  tem- 
perament, further  evidenced  by  paroxysms  of  laughing  and  weeping 
often  without  cause  or  on  the  slightest  provocation,  and  by  sulky 
spells  of  several  hours'  duration.  Both  obstinate  and  passionate,  he 
will  destroy  clothing  and  furniture  under  the  influence  of  nerve- 
storms.  Understanding  commands,  he  can  be  trusted,  if  willing  and 
interested,  to  do  an  errand.  Obedient  when  so  disposed,  affection- 
ate at  times,  he  is  simply  the  slave  of  a  highly  emotional  nature  with- 
out the  controlling  power  of  the  moral  sense,  in  which  he  is  abso- 
lutely lacking.  We  find  him,  therefore,  cunning,  untruthful,  vulgar, 
profane,  careless  with  fire,  heedless  of  danger,  and  a  tramp,  con- 
tinually straying  from  home.  He  is  fond  of  music,  of  animals,  of 
boys'  games,  such  as  shinny,  marbles,  and  kites,  and  also  of  dolls. 
He  is  devoted  to  babies,  whom  he  will  fondle,  yet  pinch  at  the  same 
time.  He  likes  to  play  with  little  children,  whom  he  will,  never- 
theless, terrorize,  but  older  boys  tease  and  enrage  him. 

The  physical  examination,  made  in  company  with  my  assistant, 
showed  the  boy  to  be  undersized — height  5  feet  i£  inches — of 
slender  build,  but  body  well  nourished  and  muscular  development 
good.  Weight  98  pounds ;  muddy  complexion ;  sullen  expression 
when  features  are  at  rest,  but"  at  other  times  pleasant.  Eyes  dark 
brown  (maroon),  bright,  restless,  and  alert.  "Thumb-sucking 
mouth,"  1 J  inches  in  length  and  y|  of  an  inch  in  breadth;  lips 
full,  thick,  and  apart,  with  slight  protrusion  of  tongue  and  marked 
sialorrhcea.  Teeth  fairly  regular  and  in  good  condition  in  superior 
maxilla,  but  somewhat  decayed  in  the  inferior ;  upper  teeth  protrude 
noticeably,  the  lower  also  but  in  a  less  degree.  Hard  palate  wide, 
fairly  well  formed,  and  but  slightly  corrugated.  Postnasal  aden- 
oids ;  tonsils  somewhat  enlarged ;  uvula  small  and  pointed ;  tongue 
clean. 


3  I  8  THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER. 

Stammers  slightly ;  articulation  defective  and  pronunciation  care- 
less, invariably  substituting  f  for  th,  as  in  "  fink "  for  think, 
"  fought  "  for  thought,  and  "  fird  "  for  third.  Asymmetry  of  face 
noticeable;  slightly  fuller  on  left  side  along  ramus  of  inferior  max- 
illa, and  on  left  side  at  angle  of  mouth ;  infra-orbital  region,  left  side, 
slightly  fuller  than  right. 

Small  scar  over  right  eyebrow  and  several  small  scars  on  fore- 
head. Hair  dark  chestnut,  coarse,  thick,  wiry,  and  stubborn,  so  that 
examination  of  head  and  measurements  were  made  with  some  diffi- 
culty. Head  narrow  through  occipital  region,  and  compressed  and 
flattened  at  parieto-occipital  junction.  Frontal  bones  somewhat  re- 
ceding ;  parietal  region  flat  and  narrow,  with  slight  tendency  to 
prominence  of  parietal  cornu.  Temporal  bones  fairly  good.  The 
head  measurements,  although  showing  nothing  so  pronounced  as  to 
attract  the  attention  of  the  ordinary  observer,  are  yet  far  from  nor- 
mal :  Bimastoid,  14  in. ;  binaural  arc,  14  in. ;  greatest  circumference, 
21^  in.;  trachelobregmatic  arc,  22  in.;  glabella  to  occipital  pro- 
tuberance, 12  in. 

Right  ear,  double  tragus;  length,  2T\-  in. ;  breadth,  iT5^  in.  Un- 
usually large  lobule,  thick,  corrugated  and  square ;  length,  f  in. ; 
breadth,  1  in.  Rudimentary  tubercle  of  Darwin.  Angle,  45  de- 
grees plus. 

Left  ear,  double  tragus;  length,  2^  in.;  breadth,  1^  in.  Lobule 
not  quite  so  wide  and  thick  as  the  right ;  length,  f  in. ;  breadth,  \^ 
in.     No  tubercle  of  Darwin.     Angle,  45  degrees  •  plus. 

Circumference  of  chest  at  nipples,  29  in. ;  circumference  of  chest 
at  xiphoid,  28  in. ;  circumference  of  abdomen  at  umbilicus,  27-I  in. ; 
circumference  of  right  arm,  8  in. ;  circumference  of  left  arm,  8£  in. ; 
length  of  right  arm,  10  in. ;  length  of  left  arm,  10  in. ;  circumference 
of  right  forearm,  8  in. ;  circumference  of  left  forearm,  8  in. ;  length 
of  right  forearm,  i6£  in. ;  length  of  left  forearm,  16^  in. ;  circum- 
ference of  right  thigh,  16  in. ;  circumference  of  left  thigh,  16  in. ; 
length  of  right  thigh,  15  in. ;  length  of  left  thigh,  15  in. ;  circumfer- 
ence of  right  leg,  n-|  in. ;  circumference  of  left  leg,  11^  in. ;  length 
of  right  leg,  18  in. ;  length  of  left  leg,  18  in. 

Right-handed,  but  the  hands,  which  are  bathed  constantly  in  per- 
spiration, are  slightly  asymmetric.  Little  finger  of  right  hand  is 
shorter  than  the  left.  Index-finger  of  right  hand  has  cicatrix  on 
palmar  surface.     Small  scar  on  dorsum  of  left  hand. 

Sensation  normal. 

Sight  normal.  Pupils  equal  and  react  to  light;  focal  distance 
about  fourteen  inches. 

Hearing,  as  tested  with  watch,  normal. 

Smell  normal.     Tests  were  made  with  mustard,  cloves,  pepper, 


THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER.  319 

camphor,  vinegar,  and  ammonia.  Of  the  mustard,  he  said :  "  It  is 
some  of  that  cheap  mustard  " ;  and  of  the  cloves,  "  I  don't  know  the 
name,  but  they  are  black  things  that  you  put  in  catsup." 

Taste  normal.  Upon  being  tested  with  sugar,  vinegar,  salt,  alum, 
quinine  and  tannic  acid,  he  said :  "  That's  quinine,  I  hate  it ;  had  to 
take  it  for  a  year  " ;  and  of  alum :  "  White  like  a  rock,  bitter  " ; 
after  a  time  he  remembered  its  name ;  of  tannic  acid :  "  It  is  bitter, 
like  a  root." 

Gait  sluggish  and  slightly  shuffling,  stamps  in  going  up  or  down 
stairs.     Perfect  coordination;  station  good.     Knee-jerk  increased. 

Slight  dilatation  of  the  capillaries. 

Temperature  in  both  axillae,  980  F. ;  in  mouth,  99  °  F.     Pulse  96. 

Heart  normal  in  position,  size,  and  action. 

Respiration,  24  a  minute. 

Appetite  and  digestion  good.  Liver,  spleen,  kidneys,  and  blad- 
der normal. 

On  my  first  visit  to  the  prison,  I  found  the  boy  dull,  but  evincing 
in  conversation  that  erratic  and  contradictory  tone  peculiar  to  the 
imbecile.  Wishing  to  test  his  memory  and  articulation,  I  asked 
him  to  repeat  the  sentence,  "  Around  the  rugged  ruin  the  ragged 
rascal  ran,"  which  he  did  fairly  well.  Chatting  further  with  him 
on  general  subjects,  I  asked  if  he  could  make  a  kite.  "  Yes,"  he 
replied,  "  but  it  is  cheaper  to  buy  one ;  you  can  buy  one  for  a  penny, 
but  when  you  make  it  you  have  to  buy  your  paper  and  get  your 
string  and  paste,  and  you  might  cut  your  finger  while  you  are  cutting 
your  sticks,  for  a  knife  often  slips."  At  my  next  visit,  in  company 
with  his  counsel  some  weeks  later,  Sam  had  forgotten  me  until  I 
repeated  "  Around  the  rugged  ruin,  etc.,"  when  he  smiled  and 
brightened  up.  No  allusion  to  the  crime  had  been  made  on  the  oc- 
casion of  my  previous  visit,  but  now  when  I  broached  the  subject, 
he  replied  quite  readily  to  interrogations,  although  with  his  usual 
contradictions,  until  sharply  rebuked  by  the  lawyer.  Out  of  the 
tissue  of  mingled  falsehood  and  illogical  admissions  was  his  confes- 
sion drawn. 

"  Sam,  I  want  you  to  tell  us  all  about  killing  Percy  Lockyer." 

No  answer. 

"  What  are  you  here  for  ?  " 

"  Killing  Percy  Lockyer." 

"When  did  you  kill  him?" 

"  Fourteenth  of  January,  this  year." 

"  How  did  you  kill  him  ?  " 

"  Just  killed  him." 

"  With  what  did  you  kill  him?  " 

"  With  a  knife." 


320  THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER. 

"  Where  did  you  strike  him  ?  " 

"  Right  here  "  (placing  his  hand  over  the  prsecordial  region). 

"  What  sort  of  a  knife  did  you  use  ?  " 

"  Potato  knife." 

"Why  did  you  kill  him?" 

"  For  calling  names." 

"  What  names  did  he  call  you  ?  " 

"  Indian,  Possum-law,  Nigger-lip." 

"  Sam,  what  did  he  mean  by  possum-law  ?  " 

"  Oh !  He  just  put  the  law  to  it." 

"  When  you  struck  Percy,  what  did  he  do  ?  " 

"  He  dropped." 

"  I  thought  you  tied  him  to  a  tree." 

"  I  didn't  tie  him  to  a  tree." 

"Why  did  you  kill  him?" 

"  For  calling  names." 

"  What  did  he  do  when  he  fell?  " 

"  Just  lay  there,  stretched." 

"  Did  you  mark  him  ?  " 

"  Marked  him  in  the  face." 

"  How  did  you  mark  him  ?  " 

"  Hit  him  with  the  knife." 

"  Where  did  you  hit  him  ?  " 

"  Hit  him  here  and  here  (placing  his  finger  on  the  parts  of  his 
face),  and  then  he  stretched." 

"  Why  did  you  mark  him  ?  " 

"  To  disfigger  him." 

"  Why  did  you  disfigure  him  ?  " 

"  Because  they  couldn't  tell  him." 

"  What  did  you  do  with  him  after  that  ?  " 

"  Put  him  in  the  creek." 

"  And  then  what  did  you  do  ?  " 

"  Put  two  rocks  on  him." 

"  What  did  you  do  then  ?  " 

"  Went  home." 

"  What  did  you  do  when  you  went  home  ?  " 

"  Just  the  usual  way." 

"  What  do  you  mean  by  '  the  usual  way  ?  '  " 

"  Cut  sticks,  made  supper,  spread  the  table,  made  coffee." 

"  Tell  me  how  you  make  coffee." 

"  Just  put — you  know  there  are  five  in  the  family — five  or  six 
tablespoonfuls  of  coffee  in  a  kettle ;  some  put  coffee  essence  in,  some 
people  don't ;  we  always  do  put  coffee  essence  in ;  then  after  awhile 
put  a  cup  of  cold  water  in,  and  put  a  rag  over  it  because  it  won't 
lose  strength." 


THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER.  32 1 

"  What  happened  after  you  went  home  ?  " 

"  They  were  looking  for  him  over  the  street." 

"  Where  did  you  go  ?  " 

"  Stayed  around  the  house." 

"  Who  came  to  see  you?  " 

"  Sergeant  Murphy." 

"  What  did  he  ask  you  ?  " 

"  Do  you  know  where  the  boy  is  ?  " 

"What  did  you  tell  him?" 

"  Yes.     He  took  me  over  to  show.     I  didn't  show  him  right." 

"  What  did  Sergeant  Murphy  do  then  ?  " 

"  Took  me  down  and  locked  me  up.     I  did  not  tell  the  truth." 

"  Why  did  you  show  him  the  wrong  place  ?  " 

"  Four  policemen  told  me  not  to  tell.  They  were  all  good  friends 
of  my  father." 

"  Now  tell  me  why  you  showed  him  the  wrong  place." 

"  To  get  out  of  it." 

"  Will  you  ever  do  anything  so  wrong  again  ?  " 

"  Pennsylvania  won't  hold  me  once  I  get  out." 

"  Where  will  you  go  ?  " 

"  Out  West,  to  my  aunt." 

In  direct  contrast  to  the  apparent  callousness  shown  in  this  nar- 
ration we  note  his  fondness  for  dolls,  his  love  for  babies,  his  care 
for  children  (manifested  in  his  lifting  the  little  boy  on  his  shoulder 
over  the  muddy  fields),  and  his  love  for  animals,  evidenced  in  a 
story  of  a  pet  squirrel  that  had  escaped.  He  told  me  how  it  had 
stopped  now  and  then  to  look  at  him  as  it  leaped  from  tree  to  tree 
in  its  efforts  for  freedom.  "  My  sister  wanted  me  to  hit  it,  but, 
oh!  I  couldn't,  I  couldn't.  But  she  did,"  and  his  eyes  grew  large 
and  misty  as  he  told  me  how  "  it  dropped  and  didn't  move  any 
more." 

"  But  you  killed  little  Percy,"  I  said. 

"  Oh — yes — that — that — was  different." 

He  had  acquired  all  the  argot  of  the  prison :  told  how  he  amused 
himself  by  putting  pepper  on  candy,  lowering  it  through  the  window 
by  a  string  to  the  prisoner  in  the  cell  below,  and  how  intensely  he 
enjoyed  it  when  the  man  swore  at  him ;  how  he  talked  to  the  other 
prisoners  through  the  closet-pipes  and  registers,  and  how  in  this 
way  news  was  transmitted  from  cell  to  cell ;  also  how  he  had  been 
initiated  into  the  mysteries  of  the  "  wall  telegraph,"  another  means 
of  communication ;  how,  on  the  first  night  he  came,  the  prisoners 
were  all  anxious  to  know  who  he  was,  and  finally  the  inmate  of  the 
cell  adjoining  had  taught  him  the  telegraph  taps,  and  how  they  bade 
each  other  good-night  by  this  means,  through  wall  after  wall  and 


322  THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER. 

tier  above  tier.  He  said  that  this  was  against  the  rules,  and  he  would 
get  a  "  flamming  "  if  caught,  but  he  would  give  me  an  example  if 
I  would  watch  so  that  the  keeper  might  not  surprise  him — indeed, 
through  it  all,  he  himself  kept  a  furtive  eye  on  the  door.  When  his 
dinner  came,  he  showed  how  he  piled  up  his  boxes  of  playthings  in 
front  of  the  register  to  keep  the  food  warm,  saying,  "  I  always  do 
this  on  Sunday  with  half  my  dinner,  as  they  don't  give  us  any  sup- 
per Sunday  night." 

On  the  occasion  of  my  next  visit,  I  found  him  very  much  dis- 
tressed and  searching  anxiously  for  something,  which,  at  last,  to  his 
great  delight,  he  found.  It  proved  to  be  only  a  small  card — an 
advertisement  of  playing-cards — that  he  valued  very  highly. 

Rough  as  he  was  at  times,  politeness  with  him  seemed  in  a  meas- 
ure intuitive.  Once,  while  making  the  examinations,  in  turning 
suddenly  we  came  in  contact,  and  he  said,  "  Excuse  me."  Twice,  I 
dropped  my  pencil,  which  he  immediately  picked  up. 

Asking  if  he  would  like  to  have  a  book,  he  replied :  "  No ;  my  law- 
yer told  me  not  to  read  much.  I  get  the  Sunday  World;  that  gives 
me  more  news  than  any  other  paper.  But,"  he  continued,  "  I  don't 
read  about  the  blowing  up  of  the  '  Maine.'  It  makes  me  nervous, 
and  I  can't  sleep."  Asked  if  he  played  with  dolls,  he  looked  up  in 
a  cunning  way  and  replied :  "  Mother  told  you  that  "  ;  then  crossing 
the  cell  to  a  table,  whereon  lay  three  paper  dolls,  his  eyes  suddenly 
filled  with  tears  and  his  lips  quivered  when  he  found  the  dress  of 
one  torn. 

In  common  with  all  imbeciles,  his  egotism  is  extreme.  "  Did  you 
see  anyfing  in  the  papers  about  me?"  he  asked.  "What?"  "I'll 
show  you ;  I  cut  'em  out,"  and  he  proudly  produced  from  a  little 
note  book  a  number  of  newspaper  clippings  relating  his  first  appear- 
ance in  court.  "  I  went  to  plead  guilty  and  I  fought  maybe  you  was 
there,"  he  said.  He  called  my  attention  to  the  point  that  the  papers 
made  of  his  being  insane.  "  But,  Sam,  you  are  not  insane,  are 
you  ?  "  I  said.  He  laughed  and  replied,  "  I  don't  know ;  but  I'm 
sorry  I'm  the  fellow  as  done  it."  "  Would  you  do  the  same  thing 
again  if  you  were  let  out  ?  "     "  No,  I've  had  lesson  enough." 

As  I  turned  to  leave  him,  he  said :  "  I  want  to  tell  you  somefing. 
When  I  went  to  court — after  I  got  home  I  sweat  awful  and  I  have 
slept  worse  at  night  since  I  went  to  court.  I  had  the  headache," 
pointing  to  his  forehead,  "  there  all  day  yesterday.  The  people  are 
so  dreadful  here,  yelling  and  knocking,  and  then  the  cats  outside  are 
so  bad.  I  wish  I  had  a  pistol  so  as  I  could  kill  'em,"  and  then  he 
laughed. 

The  trial  was  a  speedy  one,  covering  in  three  days  the  examina- 
tion of  thirty-three  witnesses  on  the  part  of  the  Commonwealth,  in- 


THE    CASE   OF   SAMUEL    HENDERSON,    MURDERER.  323 

eluding  expert  testimony,  and  three  for  the  defense — the  mother  of 
the  prisoner,  my  personal  assistant,  Dr.  Frank  White,  and  myself. 
Exhaustive  arguments  were  made  by  the  lawyers  on  both  sides,  and 
after  a  thoughtful  and  impartial  summing  up  in  the  charge  to  the 
jury,  a  verdict  was  returned  of  murder  in  the  second  degree,  based 
on  irresponsibility.  The  judge  deferred  sentence,  but  finally,  after 
consideration,  sent  the  boy  to  the  penitentiary  for  twenty  years,  as 
the  only  means  of  protecting  alike  society  and  the  poor  unfortu- 
nate. This  verdict  is  clearly  defined  in  a  subsequent  opinion  given 
by  Mr.  W.  G.  Keir,  the  defendant's  counsel :  "  The  law  of  Penn- 
sylvania has  made  no  provision  for  the  conditions  of  limited  respon- 
sibility in  individuals  as  regards  criminal  liability.  There  is  only 
one  verdict  that  may  be  rendered  in  relation  to  a  condition  of  mental 
weakness  and  that  is,  '  Not  guilty,  on  the  ground  of  insanity.'  In 
the  Henderson  case  such  a  verdict  was  not  rendered,  but  a  verdict 
of  '  Guilty  of  murder  in  the  second  degree.'  The  Commonwealth 
pressed  for  a  verdict  of  murder  in  the  first  degree,  and  if  the  jury 
had  believed  the  evidence  produced  by  the  Commonwealth  to  be 
true,  there  was  no  other  course  for  them  but  to  render  such  a  ver- 
dict. Their  four  or  five  medical  experts  testified  as  to  the  full 
sanity  of  the  defendant,  and  as  the  evidence  further  showed,  if  such 
was  the  condition  of  his  mind,  the  murder  was  willful,  deliberate 
and  premeditated.  Therefore  under  the  statute,  the  defendant  was 
guilty  of  murder  in  the  first  degree.  The  jury  undoubtedly  failed 
to  believe  the  testimony  of  the  medical  experts  for  the  prosecution, 
but  certainly  did  consider  as  true  the  testimony  offered  for  the  de- 
fendant, as  they  rendered  a  verdict  in  accordance  with  the  evidence 
of  the  defense. 

"  This  testimony  indicated  a  limited  responsibility  on  the  part  of 
the  defendant.  The  testimony  did  not  show  that  he  was  totally 
irresponsible,  but  that  there  was  a  lack  of  full  mental  power  owing 
to  a  congenital  weakness.  The  jury,  believing  that  the  boy  was 
weak-minded,  thought  it  would  be  exceedingly  unsafe  to  set  him 
free  and  rendered  a  verdict  of  '  murder  in  the  second  degree '  with 
the  thought  undoubtedly  in  their  minds  that  it  would  mean  cus- 
todial care  for  some  years  to  come,  as  finding  him  '  not  guilty  on  the 
grounds  of  insanity '  would  probably  give  him  entire  freedom,  and 
juries  only,  as  a  rule,  acquit  on  the  ground  of  insanity  where  the 
defendant  is  plainly  a  raving  maniac." 

In  the  impaneling  of  the  jury  it  was  difficult  to  find  "  twelve  good 
men  and  true  "  who  either  had  not  formed  a  previous  opinion  or 
were  not  at  once  prejudiced  by  the  appearance  of  the  boy.  The 
District  Attorney  outlined  for  them  the  different  degrees  there  were 
to  consider.     "  The  law,"  he  said,  "  divides  the  age  of  responsibility 


324  THE    CASE   OF   SAMUEL    HENDERSON,    MURDERER. 

into  three  parts.  Under  seven  years  no  one  can  commit  a  crime. 
Between  the  ages  of  seven  and  fourteen  the  law  takes  a  step  for- 
ward, and  says  one  may  commit  a  crime,  even  the  highest  kind,  but 
the  burden  of  showing  capacity  to  commit  crime  rests  on  the  Com- 
monwealth. From  the  age  of  fourteen  to  twenty-one  another  step 
forward  is  taken.  Then  the  presumption  of  the  law  is  that  a  per- 
son is  responsible  and  capable  of  committing  crime. 

"  The  prisoner  had  passed  the  age  of  fifteen  by  a  few  months.  In 
his  case,  therefore,  is  a  presumption  of  sanity  until  the  contrary  is 
proved,  and  a  presumption  of  his  innocence  until  he  is  proved 
guilty."  He  then  explained  that  under  the  indictment,  four  verdicts 
could  be  found:  Not  guilty,  on  the  ground  of  insanity;  murder  in 
the  first  or  in  the  second  degree;  and  manslaughter.  If  there  was 
a  specific  intent  to  take  life,  it  was  murder  in  the  first  degree,  and 
he  hoped  to  prove  to  the  jury  that  this  boy  was  guilty  of  murder 
in  the  first  degree  or  that  he  was  innocent  because  he  was  insane. 

The  expert  witnesses  for  the  prosecution  included  a  number  of 
well-known  specialists,  each  eminent  in  his  own  particular  line,  yet 
claiming  no  specific  experience  in  idiocy  or  imbecility.  Opportu- 
nity they  had  had  for  a  comparative  study  of  mental  conditions  and 
diseases  of  children  in  cases  occurring  in  their  practice,  but  they 
could  not  be  so  familiar  with  imbecility  as  was  one  who  had  made 
it  a  life  study. 

It  is  impossible  to  comprehend  or  apprehend  the  eccentricities,  the 
vagaries,  the  thousand  and  one  contradictions,  the  infinite  phases  of 
abnormality,  that  shade  off  and  merge  so  as  to  render  difficult  even 
a  broad  classification  of  some  cases  of  imbecility  after  weeks,  often 
months,  of  careful  observation. 

It  is  not  to  be  wondered  at,  therefore,  that  the  experts  for  the 
defense,  in  common  with  the  general  public,  refused  to  accept  the 
many  contradictions  that  are  included  in  my  daily  experience, 
namely,  that  a  defective  may  have  a  phenomenal,  but  no  residual, 
memory ;  that,  often  more  clever  than  a  normal  child,  he  may  de- 
velop capacity  for  music,  drawing,  or  painting  to  an  unusual  degree, 
and  yet  be  absolutely  lacking  in  ability  to  perform  the  simplest  pri- 
mary school  work ;  that  he  may  be  trained  to  work  in  one  line  or 
routine  in  which  he  may  be  trusted  perhaps  with  a  certain  degree 
of  responsibility,  although  outside  of  that  one  thing  his  childish 
heedlessness  may  cause  ruin  or  disaster ;  that  a  certain  inhibition  to 
pain  peculiar  to  his  class  may  permit  one  to  watch  with  perfect  com- 
posure the  amputation  of  his  own  finger,  and  yet,  on  account  of  a 
certain  lack  of  quality  in  his  general  physical  make-up,  he  would 
succumb  readily  to  some  trivial  ailment.  In  the  same  way  an  emo- 
tional nature  is  coupled  with  an  utter  lack  of  will-power,  and  poor 


THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER.  325 

judgment  makes  him  the  victim  of  nerve-storms,  alternating  between 
tenderness  and  cruelty  without  logical  cause  or  reason,  amounting 
often  to  an  utter  absence  of  moral  sense — a  nature,  therefore,  an- 
chorless. These  are  but  a  few  of  the  facts,  familiar  to  workers 
among  the  feeble-minded,  which  the  world  in  general,  including 
many  scientists,  cannot  grasp. 

The  experts  for  the  Commonwealth  agreed  as  to  finding  the  boy 
untruthful,  vulgar,  and  profane,  with  criminal  tendencies,  but  in 
their  opinion,  judging  from  his  own  version,  he  could  not  have  been 
insane  at  the  time  of  the  commission  of  the  crime,  nor  did  he,  dur- 
ing their  examinations,  exhibit  any  signs  of  imbecility. 

The  head  measurements  they  affirmed  to  be  normal — they  had 
found  no  asymmetries  other  than  those  often  met  with  in  normal 
persons,  and  no  evidence  why  the  prisoner  should  be  considered 
irresponsible.  This  opinion  was  adhered  to  in  full  view  and  in 
the  presence  of  the  malformed  head,  the  drooling  mouth,  and  the 
idiotic  grin  of  the  boy  who  leered  from  the  prisoner's  dock  even 
when  the  verdict  was  rendered. 

During  my  study  of  the  case,  I  was  careful  to  secure  the  head 
measurements  of  eleven  boys — ages  ranging  from  13  to  15  years — 
selected  at  random  by  the  principal  of  a  public  school  as  average 
types,  and  in  no  single  instance  did  they  correspond  with  those  of 
Henderson. 

Careful  anthropometric  examinations  and  subsequent  study  of  the 
family  history,  together  with  repeated  conversations  with  the  boy 
and  with  his  parents,  have  convinced  me  that  even  if  he  had  not 
committed  the  crime,  there  is  still  sufficient  evidence  to  class  him  as 
an  imbecile.  Granted  that  there  are  no  striking  asymmetries  and 
that  similar  stigmata  may  be  met  with  in  normal  people,  such  a  com- 
bination as  existed  here  could  never  be  found  in  any  one  normal 
person.  Thus  it  is  impossible  to  picture  a  healthy,  happy,  careless 
boy,  within  six  years  of  attaining  his  majority,  who  laughs  and 
weeps  many  times  a  day  without  cause,  who,  finding  in  little  children 
his  dearest  playfellows,  could  calmly  recite  the  murder  of  one,  al- 
though shrinking  at  the  thought  of  the  death  of  a  squirrel  that  for 
him  to  kill  was  an  impossible  thing;  who,  indifferent  to  the  loss  of 
home  and  friends,  listening  with  a  leer  to  a  verdict  that  might  bring 
him  life  imprisonment,  would  yet  shed  copious  tears  over  the  torn 
dress  of  a  paper  doll.  The  boy,  like  so  many  of  his  class,  is  a  series 
of  contradictions :  he  is  tender  and  cruel,  ingenuous  and  crafty, 
phlegmatic  and  nervous,  unfeeling  and  yet  affectionate ;  he  is  open, 
frank,  artless,  secretive,  shy,  deceitful,  truthful  in  many  ways,  but 
also  an  accomplished  liar.  Thus  atavism  and  environment  have 
combined  to  form  a  moral  imbecile,  in  whom  the  moral  sense  or 


326  THE    CASE   OF    SAMUEL    HENDERSON,    MURDERER. 

moral  faculty  is  either  blunted  or  altogether  absent.  He  may  dis- 
criminate intellectually  between  right  and  wrong,  but,  being  abso- 
lutely destitute  of  will-power,  is  utterly  unable  to  resist  evil  im- 
pulses. 

This  theory,  derived  from  and  verified  by  actual  investigation  of 
thousands  of  defectives  in  every  stage  of  existence,  demonstrates  the 
presence  of  a  dangerous  element  in  our  midst,  an  element  unpro- 
tected and  unprovided  for.  The  safety  of  society,  therefore,  de- 
mands its  speedy  recognition  and  separation,  in  order  to  arrest  a 
rapid  and  appalling  increase,  and,  furthermore,  its  permanent  deten- 
tion lest  it  permeate  the  whole  body  socialistic.  So  much  for  self- 
preservation — the  egoistic  side  of  the  question!  But  there  are  also 
altruistic  considerations :  the  duty  of  society  toward  the  unfortunate 
and  innocent  perpetrators  of  motiveless  crimes,  of  whom  Henderson 
is  a  fitting  type.  By  what  right,  human  or  divine,  does  society,  in 
this  age  of  civilization,  first  prepare  and  educate  him  for  the  high- 
ways of  vice,  placing  in  his  hands  instruments  of  ill — for  that  is 
what  the  co-education  of  abnormal  and  normal  does  do — then,  after 
the  deed,  which  is  but  the  natural  outcome  of  this  abnormal,  ignor- 
ant training  and  neglectful  care — by  what  right,  I  repeat,  does  so- 
ciety consign  this  innocent  irresponsible  to  an  environment  that  can 
only  foster  evil  tendencies  ?  The  penitentiary  is  for  him  but  an  ad- 
vanced training  school  for  vice,  from  which,  after  a  term  of  years, 
he  goes  out  branded,  with  no  other  inclination,  too  often  with  no 
other  resource,  but  to  repeat  a  former  experience,  being  now  in  ten- 
fold degree  a  menace  to  the  social  welfare. 

It  is  not  for  the  mother  whose  child  is  dead  for  whom  we  should 
feel  the  deepest  sympathy,  but  rather  for  her  who  lives  in  the  val- 
ley of  sorrow,  and  who  never  can  bury  her  dead  out  of  sight  nor 
know  true  peace  until  her  boy  has  passed  to  that  far  country  where 
dreams  come  true,  where  griefs  are  changed  to  joys,  and  hopes  to 
realities. 


CHAPTER   XXI. 


STORIES   OF   THE    CHILDREN. 


The  following  tales  are  told,  not  so  much  with  a  view  to  enter- 
tain as  from  a  desire  to  show  the  mother  wit  of  which  even  men- 
tally feeble  children  are  not  devoid.  The  compositions  and  letters 
illustrate  in  a  fair  degree  the  results  attainable  through  special  train- 
ing :  the  peculiar  mental  condition  is  evidenced  in  some,  while  others 
show  the  instability  of  thought  and  purpose. 

My  predecessor,  Dr.  Isaac  N.  Kerlin,  one  day  during  Sunday- 
school,  was  relating,  in  a  graphic  manner,  the  story  of  Joseph  and 
his  brethren,  and  waxing  eloquent,  as  the  climax  approached,  he 
questioned :  "  Children,  what  did  Joseph  say  when  he  saw  the  long 
line  of  his  returning  brethren?"  Immediately  one  little  fellow,  of 
high-grade — the  page  who  received  and  ushered  in  guests — piped 
up :  "I  know.  He  said :  just  walk  into  the  parlor,  gentlemen, 
and  I  will  speak  to  the  matron." 

On  another  occasion,  repeating  the  text :  "  Come  unto  Me,  etc.," 
the  Doctor  gravely  asked :  "  Who  said  that  ?  "  The  large  hall  was 
quiet,  and  his  voice  rang  clearly  a  second  time:  "  Who  said  that?" 
Still  no  response.  Then  looking  down  the  hall  and  pointing  to  a 
group  of  boys,  again  he  demanded  in  louder  tones :  "  Who  said 
that  ? "  "I  don't  know,"  shouted  back  a  low-grade  boy,  "  but  I 
didn't." 

On  yet  another  occasion,  at  evening  prayers,  Dr.  Kerlin  quoted 
the  text :  "  In  my  Father's  House,  etc.,"  and  told  the  children  he 
would  call  on  some  one  to  repeat  it  at  the  Sunday  service.  When 
the  call  was  made  no  one  ventured  to  reply.  The  silence  was  grow- 
ing embarrassing,  when  a  low-grade  stammering  boy  unrolling  him- 
self like  an  anaconda,  growled  out :  "  In  my  Father's  house  are 
magic  lanterns,  and  if  it  hadn't  a  bin  so,  I  just  wouldn't  'a  tole  you 
nothin'  about  it." 

Once  while  making  my  rounds,  I  found  a  girl  of  low-grade, 
weeping  bitterly.  Upon  inquiring  the  cause  she  sobbed  out :  "  Oh 
Doctor,  I  believe  I'm  crazy.  If  I  die,  won't  you  cut  my  head  open 
and  see  if  there  is  any  sawdust  in  my  brain  ?  "  Then  brightening 
up  somewhat,  she  added :  "  Won't  you  have  Company  A  march  to 
my  funeral  and  have  the  band  play  '  Safe  in  the  Arms  of  Jesus  '  ?  " 

327 


328  STORIES   OF   THE    CHILDREN. 

The  assurance  that  the  funeral  should  be  all  that  she  desired  soon 
restored  her  accustomed  cheerfulness. 

A  low-grade  girl,  on  account  of  her  boisterous  language  and 
persistent  disobedience,  was  a  great  trial  to  all  in  charge.  I  was 
the  only  man  with  whom  she  came  in  contact — all  intercourse 
between  the  boys  and  girls  being  absolutely  forbidden — and  not- 
withstanding her  many  disciplinings,  she  was,  after  each  lapse, 
always  eager  to  regain  my  good  opinion.  Once,  after  a  particularly 
stormy  day  that  had  worn  out  both  her  attendants  and  herself,  she 
was  overheard  to  add,  after  faltering  through  her  evening  prayer: 
"  Now,  Lord,  please  don't  allow  Dr.  Barr  to  be  bad  friends  with 
me,  for  you  know,  dear  Lord,  how  hard  it  is  to  keep  a  gentleman 
friend  in  this  place." 

A  number  of  little  boys  of  high  grade,  ranging  in  age  from  7  to  10 
years,  determined  to  be  very  naughty,  and  refusing  to  obey  were 
given  only  bread  and  milk  for  one  entire  day,  as  a  means  of  disci- 
pline. At  bed-time,  one  of  the  ring  leaders,  with  the  face  of  an 
angel,  asked  if  he  might  say  a  prayer  for  the  club.  Permission 
being  granted,  he  offered  the  following :  "  Dear  God,  please  make 
us  boys  all  good  to-morrow,  speak  the  truth,  be  obedient  and  good 
to  our  teachers,  mind  our  attendants,  and  be  good  for  everybody. 
We  have  been  in  so  much  trouble.     For  Christ's  sake,  Amen." 

A  high-grade  boy,  who  had  given  much  trouble  to  friends  at 
home,  with  us  under  supervision  did  excellent  work.  At  the  close 
of  the  school-year,  his  father  on  taking  him  home  for  vacation 
requested  me  to  impress  upon  him  that  I  was  willing  for  him  to 
remain  only  two  weeks.  This  I  did,  and  he  seemed  entirely  satisfied. 
On  the  twelfth  day,  I  was  called  to  the  'phone  by  Mr.  A.,  who  said 
that  his  son  had  given  so  little  trouble,  and  was  so  obedient  that 
he  had  determined  to  keep  him  at  home  for  six  weeks.  I  replied 
that  of  course  the  matter  was  in  his  own  hands,  and  that  he  could 
do  as  he  pleased.  Thanking  me  most  effusively  for  my  interest  in 
his  son,  he  added :  "  He  has  been  smoking  a  little,  contrary  to 
orders  I  know,  but  I  could  not  be  too  strict,  for  boys  will  be  boys." 
To  my  surprise  the  boy  returned  on  the  fourteenth  day  as  was  first 
decided,  and  greeted  me  with :  "  My  little  scheme  didn't  work,  did 
it?  I  was  talking  through  the  'phone  and  you  thought  it  was 
father ;   but  he  wouldn't  let  me  stay." 

A  middle-grade  boy  with  intercurrent  insanity,  imagining  that  he 
was  the  president  of  all  the  railroad  systems  in  the  United  States, 
had  a  passion  for  writing  passes.  On  one  occasion,  some  members 
of  a  theatrical  company  coming  out  to  give  a  performance,  John 
was  very  much  pleased  with  the  one  who  played  the  part  of  Romeo 
and  meeting  him  the  next  day,  he  presented  him  with  a  life  pass  over 


STORIES   OF   THE    CHILDREN.  329 

all  the  railroads.  A  few  days  later  he  met  another  man  who  asked 
him  for  a  pass,  and  he  gave  him  one  for  fifty  years.  Upon  being 
reminded  that  he  had  issued  to  the  other  a  pass  for  life,  the  boy  re- 
plied :  "  Oh !  it  is  the  same  thing.  I  have  given  you  one  for  life ; 
you  look  as  if  you  wouldn't  live  fifty  years." 

At  the  customary  weekly  inspection,  the  boys  after  their  bath, 
attired  in  their  best  suits,  are  lined  up  for  a  careful  overlooking. 
One  day,  in  response  to  the  order,  "  Right  foot  up,"  a  middle-grade 
boy  lifted  his  left  foot.  The  order  was  repeated  with  the  same 
result;  again  it  was  repeated,  and  the  left  foot  came  up  as  before. 
Being  asked  if  he  did  not  know  his  left  from  his  right  foot,  he 
replied,  indignantly :  "  Certainly  I  do."  "  Then  why  do  you  raise 
your  left  foot?"  "I  didn't,"  he  said;  "I  am  left-handed,  and  if 
I  am  left-handed  I  use  my  left  hand  as  my  right  hand,  and  I  lift 
my  left  foot  because  it  is  the  right  foot."  Such  logic  was  not  to  be 
controverted. 

A  boy  of  low  grade  upon  seeing  a  picture  of  Cupid,  covered  his 
eyes,  exclaiming :  "Shame !    Shame !    Go  put  overalls  on  him." 

Another  boy  was  one  of  a  class  shown  at  a  clinic,  as  a  pronounced 
moral  imbecile  of  low  grade.  A  few  days  later,  during  a  quarrel, 
a  companion  said :  "  Harry  you're  a  bad  boy."  "  I'm  not,"  he 
quickly  retorted,  "  I'm  Dr.  Barr's  little  margle  ingersoll." 

A  low-grade  girl  one  day  said  to  the  assistant  matron,  whose 
mother  was  in  charge  of  that  department :  "  Miss  Carrie,  I  do  like 
you.  You're  all  right,  but  I  hate  your  mother.  She  knew  how  to 
raise  you,  but  she  didn't  know  how  to  raise  herself." 

This  same  child,  friendless  and  dependent,  was  therefore  com- 
pelled to  wear  the  "  cast-off  "  clothing  of  the  more  fortunate  chil- 
dren. With  a  keen  appreciation  of  color  this  was  often  a  great 
cross,  and  one  day  given  a  dress  the  color  of  which  she  disliked,  she 
said,  sighing :  "  My !  what  a  nice  thing  it  must  have  been  to  have 
lived  after  Adam  and  Eve!  No  one  would  have  had  to  wear  their 
cast  clothes." 

One  stormy  night  I  was  summoned  to  the  reception  room,  and 
upon  entering,  was  greeted  by  a  boy  of  12  years,  who  rose  and 
held  out  his  hand  in  the  most  cordial  manner :  "  Dr.  Barr,  I  presume. 
I  am  H.  H.  who  was  to  come  to  you.  I  just  thought  I  would  not 
wait  for  my  father,  and  so  I  walked  off.  I  had  some  money  and 
begged  a  little,  and  here  I  am.  Just  telephone  to  my  father,  will 
you  ?  His  number  is  — .  I  am  afraid  he  might  be  worried."  Thus 
he  entered  himself,  and  his  father,  coming  the  next  day,  completed 
the  arrangements.  He  proved  quite  troublesome,  although  his 
improvement,  in  time,  was  marked.  Of  this,  he  himself  was  only 
too  conscious,  and  when  corrected  for  any  offense,  he  would  turn 


330  STORIES   OF   THE    CHILDREN. 

and  say,  with  the  beaming  smile  which  was  his  chief  stock  in  trade, 
and  was  used  to  cover  a  multitude  of  misdemeanors :  "  Yes,  I  know 
I  am  naughty ;  but  I  have  improved  so  much." 

A  high-grade  boy  upon  being  rebuked  for  a  misdemeanor,  replied : 
"  Well,  I'm  not  responsible  for  what  I  do,  I'm  feeble-minded." 
Nevertheless  he  found  that  he  was  held  up  to  a  certain  degree  of 
responsibility. 

A  club  of  boys,  all  high-grade,  averaging  12  years,  had  very  sweet 
voices  but  were  too  lazy  to  sing  at  evening  prayers  and  at  the  Sun- 
day service,  and  maintained  silence  notwithstanding  repeated  repri- 
mands. Finally  on  a  Saturday  afternoon,  after  the  bath  they  were 
put  to  bed  on  bread  and  milk  until  they  should  find  their  voices; 
Saturday  being  the  evening  of  the  weekly  dance,  absence  from 
"  Hall  "  was  discipline  most  severe.  The  night  passed  quietly ;  not 
a  sound  from  the  dormitory,  where  on  going  through  I  found  every 
eye  fast  closed  and  all  apparently  sleeping  the  sleep  of  the  just. 
On  Sunday  morning  the  whole  house  was  filled  with  melody: 
hymns,  songs — sentimental  and  comic — everything  went!  Upon 
entering  the  dormitory  I  found  each  boy  perched  upon  the  foot-rail 
of  his  bed,  all  singing  and  balancing  themselves  in  time  to  the  music. 
Even  a  semi-mute  who  could  speak  only  a  few  words  was  doing  his 
best.  The  voices  had  been  found  and  thenceforward  there  was  no 
more  trouble. 

A  girl  of  middle-grade,  given  to  over-indulgence  in  good  things, 
had  in  consequence  frequent  attacks  of  indigestion  which  she  called 
"  disasters."  .Early  in  my  experience,  going  with  a  co-assistant  over 
his  building,  prior  to  taking  his  duties,  while  he  was  absent  on  vaca- 
tion, he  instructed  me  in  regard  to  Mary's  treatment  during  a  "  dis- 
aster." Overhearing  this,  Mary  volunteered :  "  Doctor  you  needn't 
do  that.  Dr.  Barr  is  so  young  and  unexperienced  that  I'm  afraid 
he'll  not  know  how  to  treat  me.  So  I  won't  have  a  disaster,  'till 
you  get  back  or  I  may  die."  And  she  didn't;  but  she  was  his  first 
patient  on  the  evening  of  his  return. 

At  Christmas,  we  try  to  give  the  children  anything,  within  reason, 
that  they  particularly  desire.  One  middle-grade  boy  sent  in  his  list 
thus :  "  A  bottle  of  bear's  grease,  a  set  of  false  teeth,  and  a  Bible." 
He  got  all  three,  but  the  teeth  were  put  away  carefully  in  a  box 
for  safe-keeping  and  worn  only  on  Sundays  and  on  holidays. 

John,  an  active  middle-grade  boy  of  12,  always  in  some  scrape, 
was  devoted  to  manual  occupations  and,  eager  for  praise  was 
intensely  jealous  of  anyone  who  gained  it.  Hearing  his  teacher  one 
day  commending  a  comrade,  he  exclaimed  in  a  tone  of  disgust : 
"  Humph !  Humph !  You  think  Miles  is  a  good  deal  better  than 
me,  but  you'll  see.     When  you  get  up  there,"  pointing  upwards, 


STORIES    OF   THE    CHILDREN.  33  I 

"  you'll  not  find  Miles  with  you.  He'll  be  down  there,"  pointing 
downwards,  "  with  me.     That's  where  he'll  be." 

The  possibility  that  positions  might  be  reversed  never  seemed  to 
occur  to  him,  and  his  quietly  placing  his  teacher  without  question 
among  the  angels,  she  found  very  amusing.  Evidently  John  was 
quite  willing  to  go  to  his  own  place,  if  only  he  could  find  the  other 
fellow  there  too. 

Josiah  was  an  epileptic  of  middle-grade,  who  found  great  delight 
in  a  monotonous  reading  aloud  of  the  Scriptures.  One  day,  upon 
being  reproved  by  his  mother  unduly  as  he  thought,  although  in 
gentle  Quaker  fashion,  he  hastily  interposed :  "  There,  there,  mother. 
Don't  thee  talk  any  more.  Let  motherly  love  continue."  On  an- 
other occasion,  disappointed  in  receiving  a  promised  gift,  he  queru- 
lously complained  :  "  I  want  her  to  send  it  even  if  I  die."  "  What," 
said  the  mother,  "  if  thee  go  to  Heaven  ?  How  can  she  get  it  to 
thee  ?  "  "  She  can  send  it."  "  But  suppose  thee  goes  to  the  other 
place  ?  "     "  Oh  !  then  she  can  bring  it  to  me,"  was  the  quick  reply. 

Eddie  had  broken  his  arm,  and  the  fracture  was  so  severe  that  it 
was  proposed  to  give  him  ether.  He  had  borne  the  pain  bravely, 
but  now  began  to  cry.  When  asked  why  he  was  crying,  he  replied : 
"  Why  what's  the  use  of  having  a  broken  arm  if  you  can't  see  it 
set  ?  "  We  didn't  ■  give  the  ether,  and  the  most  interested  observer 
of  the  operation  was  the  patient  himself. 

A  high-grade  boy  aged  16  years,  a  member  of  the  carpentry  class, 
was  asked  by  the  other  boys  to  draw  up  a  program  for  an  excursion 
"  just  for  fun,"  and  he  evolved  the  following  without  assistance : 

PERSONALLY    CONDUCTED 
TOUR 

By  the  C.  S.  G.  of  P.  T.  S. 

Wednesday,  July  16,  1903. 

To  Clayton,  Del.  &  Return 

7  A.  M.  to  10  P.  M.  Incl. 

FARE,   ROUND  TRIP,   $200.00 

ALL   HOTEL  BILLS   AND   OTHER  EXPENSES    PREPAID 

TICKETS   ON   SALE  AT  BOX-OFFICE. 

Charles  Viscidi,  General  Manager 

William  H.  Ertel,  General  Passenger  Agent 


12,2  STORIES   OF   THE    CHILDREN. 

Amusements 

calathumpian  band 
Solo  Violinist,  A.  Parrillo 

Cornetist,  H.  Simmington 

Snarum  Drummist,  W.  Bibby 

Bill-of-Fare 

Shingle  Sandwiches  Fir  Board  Sawdust  Pudding 

Grindstone  Soup  Curtain   Bracket   Salad 

Fencepost  Croquettes  Chisel  Chowder  Coal-oil  Custard 

Red  Oak  Oatmeal  Planed     Potatoes     with     Sandpaper- 
Bevel  Square  Shortcake  Dressing 

Jute  Rope  Cigars  Cylinder  Oil  Soup 

Lath  Lemonade  Preserved  Sawse 

Screwdriver  Cigarettes 

Round  Robin  Cakes 

Sixty-Penny  Tooth-Picks 

Schooners  and  Other  Vessels  V.  ROCKWOOD, 

Unloaded  to  Order  Chief  Cook  and  Bottle- Washer. 

The  following  verses  are  by  two  high-grade  boys,  aged  respec- 
tively, 16  and  13  years. 

Elwyn  Day 

Elwyn  Day  will  soon  be  here 

It  only  comes  once  a  year. 

We  hope  it  dawns  bright  and  clear, 

For  that  will  fill  us  full  of  cheer. 

We  have  worked  hard  in  High-grade  A, 
And  tried  to  make  a  fine  display, 
Our  papers  for  the  month  of  May 
Will  soon  be  done  and  put  away. 

We  have  all  done  them  with  might 
And  tried  to  make  them  look  just  right, 
We  try  to  keep  them  clean  and  bright 
And  hope  they'll  make  a  pretty  sight. 

The  band  will  be  in  full  array 
And  on  the  campus  they  will  play; 
All  the  people  dressed  so  gay 
Will  come  to  see  our  Elwyn  Day. 

We  are  glad  when  the  day  is  done 
And  from  the  drill  hall  we  will  run; 
And  when  our  task  is  done 
Then  it  will  be  nothing  but  fun. 

F.  W. 

Keystone  Hall  Sayings  from  7  to  8  O'clock. 

"  I  want  this  Hall  to  come  to  order," 

Says  Miss  Kneed  to  every  boarder. 
"  Washington,  Liberty,  and  Crozer  in  line, 

Keep  quiet,  boys,  for  this  Hall  is  mine!" 


STORIES    OF   THE    CHILDREN.  333 

"  There  is  no  dancing  for  the  boys  to-night, 
For  you  turn  back — you  turn  left  and  right. 
I  want  all  the  boys  now  to  sit  down, 
This  Hall  is  not  dirty,  but  varnished  brown." 

"  I  hear  the  talking  still  going  on ; 
You  boys  start  your  acting  as  soon  as  I  am  gone. 
I  want  that  boy  sitting  beside  Sam  Pell 
To  go  over  to  Miss  McFeeley's  Hotel."1 

Now  comes  the  mail  in  Keystone  Hall, 
Then  Dr.  Barr  the  names  will  call : 
"  E.  P.  Waller,  Ben  Ridd,  and  Edward  Kay. 
Boys !   Boys !   what  do  you  mean  by  making  such  a  noise  to-day?" 

E.   W. 

Three  boys,  all  of  high-grade,  aged  respectively,  9,  10,  and  II 
years,  wrote  the  following  compositions  unassisted. 

My  Favorite  Character  in  History. 

I  think  I  like  Lincoln's  character  the  best. 

The  reason  is  because  he  was  very  studious,  and  a  very  quiet 
man,  he  always  tried  to  do  the  best  he  could  in  every  way.  He  was 
honest,  loving,  kind-hearted,  brave,  courageous,  and  helped  his 
people  in  many  ways.  He  helped  in  many  things  in  the  Civil  War, 
he  did  nearly  all  the  writing  for  the  people. 

He  used  to  read  the  few  books  over  and  over  again,  the  way  he 
gained  so  much  knowledge  was  by  reading  his  books  over  and  over 
again.  There  were  no  schools  during  that  time.  He  studied  fifteen 
hours  every  day,  that  is  three  times  as  much  as  we  study.  After 
awhile  he  got  employed,  and  got  a  half  a  dollar  a  day.  He  thought 
that  a  great  deal. 

He  was  beloved  by  every  one,  and  when  he  died,  not  only  our 
people  were  sorry  but  whole  Europe  was  too.  Because  Mr.  Booth's 
brother  killed  Lincoln,  his  band  has  never  played  there  since. 

S.  H.  J.  L. 

My  Favorite  Character  in  History. 

I  think  Benjamin  Franklin  was  just  as  good  as  any  other  great 
men  of  his  days.  He  knew  his  own  business  and  tended  to  it.  The 
way  he  saved  money  was  like  this.  When  his  father  apprenticed 
him  as  printer  to  his  brother,  he  told  his  brother  if  he  would  give 
him  half  of  what  his  board  cost  he  would  get  his  own  food.  He 
bought  a  biscuit  or  tart  to  eat,  and  the  rest  he  saved  to  buy  books 
with.  While  the  other  people  were  eating  their  meals  he  studied. 
When  he  was  in  England    (if  he  had  drank  beer  with  his  other 

1  The  boys'  name  for  the  infirmary,  where  they  are  punished  in  bed. 


334  STORIES    OF   THE    CHILDREN. 

companions)  he  probably  might  not  have  been  heard  of  to-day.  His 
father  used  often  to  say  an  old  proverb  to  him,  viz.,  "  Seest  thou  a 
man  diligent  in  his  business?  he  shall  stand  before  kings."  He  was 
presented  to  five  different  kings  before  he  died.  R.  A.  R.  P. 

My  Favorite  Character  in  History. 

In  a  great  many  ways  I  like  William  Penn  the  best;  although 
I  like  nearly  all  the  rest  of  the  men  whom  you  learn  about  in  history. 
The  reason  I  like  Penn  is  because  he  always  was  so  good  to  the 
Indians.  I  always  liked  to  hear  the  story  where  Penn  made  the 
treaty  with  the  Indians ;  also  the  story  where  he  was  put  in  prison 
for  preaching  in  the  street. 

I  always  felt  very  sorry  for  him.  J.  K.  I.  E. 

The  writer  of  this  is  a  high-grade  boy,  aged  14,  fond  of  attracting 
attention. 

"  Eywyn,  Pa.,  February  11. 
"  To  M.  &  Co.,  New  York,  N.  Y. 

"Dear  Sirs:  I  am  exceedingly  interested  in  patents,  all  the  time 
and  been  studying  out  plans  of  new  scientific. 

"  Write  and  let  me  know  at  once  if  there  is  a  copyright  or  patent 
on  a  book  called  '  The  Pictorial  Atlas  of  Pennsylvania.' 

"  I  have  it  half  written.  Besides  I  am  working  on  many  other 
things,  but  cannot  decide  witch  one  to  start  with. 

"  I  hope  you  will  grant  my  request  and  send  me  a  hand-book  on 
patents  '  free '  as  you  advertise  in  the  '  Popular  Educator.' 

"  Yours  Res., 

"  E.  W.  H., 
"  Elwyn,  Del.  Co. 

"  Pennsylvania,  U.  S.  A." 

The  following  letter  was  written  by  a  middle-grade  boy,  epileptic, 
aged  17,  with  fair  reasoning  powers: 

"Elwyn,  Pa.,  July  31. 
"  My  Dear  Father  : 

"  I  wish  you  would  leave  me  come  home  for  my  birthday  which 
is  not  far  off.  It  comes  on  the  25th  of  September,  which  is  Thurs- 
day. There  is  one  question  I  wish  to  ask  you  and  it  is  this :  if  I 
ask  you  to  take  me  home,  you  say  you  haven't  the  money  and  if  I 
run  away  why  you  seem  to  have  it  to  bring  me  back,  and  that  is 
what  puzzles  me.  I  only  wish  I  could  spend  just  one  month  with 
you,  I  would  be  more  than  satisfied,  and  you  know  I  have  been 
here  exactly  9  years  and  haven't  been  home  in  a  decent  way  yet,  and 


STORIES   OF   THE    CHILDREN.  335 

I  guess  I  never  will.  If  you  can't  give  me  a  little  change,  I  will 
have  to  make  it  myself,  I  will  never  show  my  face  near  home,  and 
you  can  depend  upon  it.     From 

"  Your  unthought  of  Son 
"  H.  F.  W." 

The  three  following  letters  are  by  a  high-grade  boy  aged  15,  who, 
most  erratic,  has  a  very  vivid  imagination. 

"  Miss  J : 

"  Here  is  one  thing  that  I  want  to  be  successful  in  a  short  time 
from  now : — I  contemplate  a  running-away  club  to  different  parts 
of  the  United  States  and  also  to  the  Philippines.  I  want  all  the 
boys  who  are  in  favor  of  starting  this  club  to-day,  to  stand  up  and 
I  will  put  down  the  names  and  do  not  be  afraid  to  stand  up.  I  want 
Miss  J.  to  send  notices  out  to  the  attendants  and  notify  of  this 
great  time.  Here  are  the  reasons : — For  more  liberty,  more  inde- 
pendence, more  sight-seeing  of  this  wide  world,  more  walks,  exceed- 
ing 20  miles  a  day  regardless  of  everything  and  a  few  more  things. 
I  want  this  to  be  a  very  secret  affair  and  please  do  not  fail  to  vote 
now.  Every  club  is  represented  and  the  thing  is  that  I  want  you 
to  take  notice  and  vote  for  this  runaway  club. 

"  Please  read  this  out  loud  and  tell  them  what  I  want  them  to  do." 

"  Elwyn,  Delaware  Co.,  Pa.,  Wed.,  November  28,  1900. 
"  Dear  Father  : 

"  I  received  your  letter  and  was  very  glad  to  hear  from  you.  I 
am  getting  along  all  right  and  feel  pretty  well.  I  get  good  food. 
We  are  getting  ideal  foot-ball  weather  in  the  United  States  now. 
Sometimes  it  is  stormy,  miserable  and  dreary  out  of  doors.  A  foot- 
ball game  will  take  place  to-morrow  and  it  is  likely  that  there  will  be 
a  very  large  crowd  to  witness  the  game.  If  we  get  defeated  it  will 
prove  a  severe  blow  to  the  foot-ball  players  of  this  place.  There 
are  11  men  on  the  Elwyn  team  and  they  are  tough  and  strong.  It  is 
very  dangerous  to  be  in  a  hotly  contested  game  of  foot-ball.  Several 
fellows  are  killed  every  year.  I  have  not  written  yet  to  Horace  or 
to  Myrtle  as  the  time  is  very  precious  here.  I  am  in  Liberty  Club 
and  it  consists  of  boys  who  behave  and  work.  Here  is  the  program 
that  everybody  must  obey :  5.30  A.  M.  get  up,  dress,  wash  and  turn 
beds  over,  6.30  A.  M.  go  to  breakfast  which  lasts  30  minutes.  7:15 
to  8 130  A.  M.  daily  dry-scrub,  9  :oo  A.  M.  to  12  :oo  noon  school, 
12  :3o  P.  M.  to  1  :oo  P.  M.  dinner  which  lasts  30  minutes,  1  :oo  P.  M. 
to  1 150  P.  M.  dish  washing  by  some  clubs.  2  :oo  P.  M.  to  4  :oo  P.  M. 
school,  4  :oo  P.  M.  to  5  :oo  P.  M.  play-hour,  5  :30  P.  M.  to  6  :oo  P.  M. 


336  STORIES    OF   THE    CHILDREN. 

supper  which  lasts  30  minutes,  6  :oo  P.  M.  to  6 150  P.  M.  dish- 
washing by  some  clubs.  7  :oo  P.  M.  to  8  :oo  P.  M.  do  different 
things,  8  :oo  P.  M.  go  to  bed,  9 145  P.  M.  reporting  time  every  night, 
10  :oo  P.  M.  to  5  :oo  A.  M.  next  morning,  night  watches.  The 
people  of  this  country  are  very  busy  and  better  still,  McKinley  and 
Roosevelt  got  elected  by  a  large  vote.  The  Democrats  were  defeated 
and  free  silver  is  dead.  Prosperity  has  revived  considerably,  and  the 
people  are  for  McKinley,  sound  money,  prosperity  and  good  times. 
I  hope  you  will  answer  this  just  as  soon  as  you  get  it.  It  is  a  long 
time  since  I  heard  from  Mrs.  N.,  and  I  think  that  the  letter  was 
mailed  to  somebody  else  in  mistake.  I  will  close  now  as  it  is  almost 
noon.  "  Yours  truly, 

"  F.  G.  W." 

"  Elwyn,  Delaware  County,  Pennsylvania. 
"  Dear  Papa  : 

"  I  am  very  sorry  to  keep  you  waiting  for  a  long  time.  I  am 
here  at  this  training  school  at  last  and  I  like  it  very  much.  The 
people  are  taking  good  care  of  me  and  are  giving  me  excellent  food 
and  attention.  Do  you  feel  lonely  in  the  Philippines  now  ?  Write  me 
a  long  description  of  your  voyage  and  tell  me  all  about  the  people, 
their  customs,  habits,  religion,  scenery,  climate  of  the  Philippines, 
etc.,  and  do  not  worry  about  me.  What  year  are  you  coming  home 
from  the  Philippines?  Are  you  coming  home  next  year  (which 
is  1905)  ?  I  feel  very  well  but  I  do  not  feel  glad.  I  feel  very  moody 
and  feel  disagreeable  about  anything.  Nothing  under  the  sun  does 
not  seem  to  please  me  and  my  thinking  powers  are  all  dead.  I 
feel  like  escaping  from  this  school  and  make  my  way  towards  New 
York  and  get  on  a  steamer  and  then  get  to  Manila  some  way.  This 
letter  is  being  written  on  February,  the  eight  instant  and  it  is  10.20 
A.  M.  and  it  is  about  12.30  A.  M.  night  at  Manila  now.  What  are 
you  doing  at  Manila  now?  I  am  determined  that  I  am  going  to 
spend  a  week  or  ten  days'  holiday  at  Whitehall  on  account  of  my 
birthday.  Please  don't  fail  to  send  me  something  from  Manila.  I 
would  rather  have  something  alive  to  be  sent  from  Manila  as  a 
Philippine  chicken  or  cock.  When  you  come  home  I  want  you  to 
buy  me  a  large  flock  of  chickens  (including  some  many  roosters) 
and  some  other  animals  and  do  not  fail  to  buy  me  these  animals. 
Virginia  and  Mrs.  A.  are  very  bad  enemies  and  I  hope  you  a 
happy  year.  The  Japanese  and  the  Russians  are  having  quite  a  war 
and  it  looks  very  dark  for  both  nations.  Baltimore  is  having  a 
tremendous  fire  and  the  loss  is  many  million  dollars  and  Philadelphia 
had  a  tremendous  conflageration  on  November  29,  1899,  and  de- 
stroyed property  valued  at  $2,000,000. 


STORIES   OF   THE    CHILDREN.  337 

Please  answer  this  letter  immediately  and  don't  fail  to  send  me 
something  interesting  from  Manila.  Do  you  wish  that  I  was  with 
you  at  Manila?  I  wish  that  I  was  at  Manila  now  and  time  is  going 
very  rapidly,  it  will  not  take  very  long  for  1905  to  come  now  but  I 
want  time  to  pass  very  slowly  for  me.  Mrs.  N.  and  I  are  very  great 
friends  now ;  even  if  we  are  separated  we  still  can  be  friends.  I  am 
going  to  walk  to  Philadelphia  some  day  soon  and  the  people  may 
let  me  go  to  Philadelphia.  I  may  get  to  Manila  some  day  soon  and 
there  is  no  use  of  me  staying  at  this  school  one  year  or  two  months. 
I  feel  discouraged  about  everything  now  and  my  future  may  be  a 
black  one.  I  lost  my  pocket-book  and  feel  angry.  You  may  in  all 
probability  will  have  to  stay  at  Manila  about  ten  years  and  I  expect 
to  be  a  discouraged  man  and  nobody  does  not  seem  to  take  care  of 
me  now.     I  want  to  be  a  great  man  and  I  will  close  now. 

"  Good  bye  for  a  time, 

"  Your  friend, 

"  F.  W." 

"  N.  B. — Please  try  with  your  utmost  power  to  make  me  to  be 
glad  and  try  to  give  me  a  warning  about  everything  and  I  want  God 
to  make  me  glad  and  try  to  make  my  life  a  happy  bright  one  on 
this  earth." 


BIBLIOGRAPHY. 
A  List  of  the  Writings  of  Edward  Seguin. 

'  Resume  de  ce  que  nous  avons  fait  pendant  quatorze  mois."    Esquirol  et 

Seguin,  Paris,  1839. 
'  Conseils  a  M.  O.  .  .  .  sur  1'  education  de  son  enfant  idiot."     Paris,  1839. 
'  Theorie  et  pratique  de  1'  education  des  idiots.     Lecons  aux  jeunes  idiots 

de  1'  hospice  des  Incurables,"  premiere  partie.     Paris,   1842. 
Idem,  seconde  partie.     Paris,  1843. 
'  Hygiene  et  education  des  idiots,"  Annales  d'  hygiene  et  de  medecine  legale. 

Paris,  1843. 
'  Images  graduees  a  1'  usage  des  enfants  arrieres  et  idiots."     Paris,  1846. 
'  Traitement  moral,  hygiene,  et  education  des  idiots."    J.  B.  Bailliere,  Paris, 

1846. 
'  Jacob  Rodrigue  Pereire,  premier  instituteur  des  sourds  et  muets  en  France." 

Paris,  1847. 
'  Historical  Notice  of  the  Origin  and  Progress  of  the  Treatment  of  Idiots." 

Translated  by  J.  S.  Newberry,  Cleveland,  O.,  1852. 
'  Idiocy :     Its    Diagnosis    and    Treatment    by    the    Physiological    Method." 

Translated  by  L.  P.  Brockett,  Albany,  N.  Y.,  1864. 
Prescription    and    Clinic    Records.     Mathematical    Tables    of    Vital    Signs, 

i865-'77. 
'  Idiocy  and  its  Treatment  by  the  Physiological  Method."     Revised  by  E.  C. 

Seguin;  William  Wood  &  Co.,  New  York,  1866. 
'  New  Facts  and  Remarks  Concerning  Idiocy."     New  York,   1870. 
'  Idiocy  as  the  Effect  of  Social  Evils  and  as  the  Creative  Cause  of  Physio- 
logical Education,"  Journal  of  Psychological  Medicine  and  Diseases  of 

the  Nervous  System.     New  York,  January,  1870. 
'  Medical  Thermometry  and  Human  Temperature,"  by  C.  A.  Wunderlich  and 

Edward  Seguin.     William  Wood  &  Co.,  New  York,  1871  and  1876. 
'  Family  Thermometry :    A   Manual   of  Thermometry  for  Mothers,   Nurses, 

etc."    Geo.  P.  Putnam  &  Sons,  New  York,  1873. 
'  Case  of  Scarlatina,  Showing  the  Importance  of  Family  Thermometry,"  in 

Brown-Sequard's  Archives  of  Scientific  and   Practical   Medicine,  No.  2, 

February.     New  York,  1873. 
'  Report   on   Education,"   Vienna   International   Exhibition,    1873.     Washing- 
ton, 1875. 
'  Psycho-physiological  Training  of  an  Idiotic  Hand."    Archives  of  Medicine, 

New  York,  1879,  Vol.  II.,  p.  149. 
'  Psycho-physiological  Training  of  an  Idiotic  Eye."    Ibid.,  New  York,  1880, 

Vol.  IV,  p.  217. 
'Report  on  Education,"  1880,  second  edition.     Milwaukee,  Wis. 

338 


CRETINISM    AND    IDIOCY.  339 

BIBLIOGRAPHY   OF   CRETINISM   AND    IDIOCY. 

"  Die  Heilung  und  verhiitung  des  Cretinismus,  etc."     Guggenbiihl,  Bern,  1835. 

"  Europe's  First  Colony  for  the  Cure  of  Cretinism."     Guggenbiihl,  Jena,  1840. 

"  On  Extensive  Cretinism,  and  the  Institution  for  its  Cure  on  the  Abend- 
berg."     Bern,  1840. 

"  Lecture  on  Cretinism  and  the  Possibility  of  its  Cure,"  meeting  of  German 
naturalists  and  physicians.     Buek,  Brunswick,  1842. 

"  Cretinism :    a  Monograph."     Otto  Thieme,  Weimar,   1842. 

"  The  Institution  for  Cretin  Children  on  the  Abendberg."  Rosch,  Stuttgart, 
1842. 

"  The  Institution  for  Cretin  Children,  Founded  by  Dr.  Guggenbiihl,  on  the 
Abendberg,  near  Interlaken."     Herkenrath,  Amsterdam,  1842. 

"  Dissertation  on   Cretinism."     Berthold   Beaupre,   Fribourg,    1843. 

"  Some  Account  of  Cretinism  and  the  Institution  for  its  Cure  on  the  Abend- 
berg."   William  Twining,  London,  1843. 

"The  Children  of  the  Abendberg."     Countess  Ida  von  Hahn,  Berlin,  1843. 

"  Sketches  of  the  Extent  of  Cretinism  in  the  Canton  Aargau."  Michaelis, 
1843. 

"  New  Researches  on  Cretinism."     Maffei  and  Rosch,  Erlangen,  1844. 

"  First  Report  on  the  Abendberg."     Guggenbiihl,  Fribourg,   1844. 

"  Extracts  from  the  Report  on  the  Abendberg."     W.  Twining,  London,  1845. 

Several  Treatises  on  Cretinism  in  the  Swiss  Society  of  Naturalists  and  Phy- 
sicians, 1840-1845. 

"  Essay  on  Cretinism."     Edward  Wells,  London,  1845. 

"  The  Institution  for  Lunatics,  and  their  Cure,  in  France  and  Germany ;  with 
the  Institution  for  Cretins  on  the  Abendberg,  in  Switzerland."  Vizanick, 
Vienna,  1845. 

"  Goiter  and  Cretinism."     Niepce,  Paris,  1845. 

"  Letters  on  the  Abendberg,  and  the  Hospital  for  Cretinism."  Guggenbiihl, 
Zurich,  1846. 

"  On  Dr.  Guggenbiihl's  Institution  for  Cretins,"  in  Chambers'  Edinburgh 
Journal,  April,  1848. 

"The  Alpine  Retreat  of  the  Abendberg."     Coldstream,  Edinburgh,   1848. 

"An  Account  of  the  Commission,  Appointed  by  Order  of  the  King  of  Sar- 
dinia, to  Inquire  into  the  State  of  Cretinism."    Turin,  1848. 

"  Memoir  on  Goiter  and  Cretinism."     Paris,  1850. 

"  The  Report  of  the  Sardinian  Commission ;  with  Observations  on  Cretinism 
and  Notices  of  the  Abendberg  Hospital,  Founded  and  Directed  by  Dr. 
Guggenbiihl,  for  the  Cure  of  Cretinism  and  Idiocy."  Alessandro  Sulla, 
Milan,  1850. 

"Report  of  the  Commission  Created  by  the  King  of  Sardinia  for  the  Study 
of  Cretinism."    Turin,  1850. 

"  Treatise  on  Goiter  and  Cretinism ;  with  Statistics  of  the  Cretins  and  Goiters 
in  the  Valley  of  the  Isere."     Niepce. 

"  Report  made  before  the  Meeting  of  the  Natural  History  Society  at  Glarus." 
Guggenbiihl,  1851. 

"Researches  on  Idiocy  and  Cretinism  in  Norway."    Stalst,  Christiania,  1851. 


34-0  BIBLIOGRAPHY. 

"  A  Periodical  Paper  on  Cretinism,  and  the  Institutions  for  its  Cure."     Edited 

by  Rosch,  Stuttgart,  1852. 
"  The  Prevention  and  Cure  of  Cretinism ;  and  the  Progress  of  the  Work," 

report  made  to  the  Swiss  Society  of  Naturalists  by  Guggenbuhl.     Huber 

&  Co.,  Bern,  1853. 
"  Cretinism  and  Idiocy."     Blackie,  Edinburgh,  1855. 
Article  on   "  Cretinism "   in  J.   Langdon  Down's   "  Dictionary  of  Medicine," 

edited  by  Richard  Quain,  1883,  p.  314. 
"  The  Morphological  and  Histological  Aspects  of  Microcephalic  and  Cretinoid 

Idiocy."     Fletcher  Beach. 
"  Psychological  Medicine."     Bucknell  and  Tuke. 

BIBLIOGRAPHY    OF   MENTAL   DEFECTIVES. 

"  Historique  sur  le  Sauvage  de  1'  Aveyron."     Bonaterre,  Paris,  1799. 

"  De  1'  Education  d'  un  Homme  Sauvage."     Itard,  Paris,  1801. 

"  Rapport  sur  le  Sauvage  de  1'  Aveyron."    Ibid.,  Paris,  1807. 

"  Essai  Philosophique  sur  les  Probabilities."     Paris,  1816,  p.  227. 

"  Observations  pour  servir  a'  l'histoire  de  lTdiotie."  Esquirol,  dans  les 
Maladies  Mentales,  Paris,  1828. 

"  Essai  sur  1'  Idiotie."     Belhomme,  Paris,  1843. 

"  D'idiotie  chez  les  enfants."  ,  Felix  Voisin,   Paris,   1843. 

"  Remarks,  Theoretical  and  Practical,  on  the  Education  of  Idiots  and  Chil- 
dren of  Weak  Intellect."    W.  R.  Scott,  London,   1847. 

"  Idiocy,"  Gaskell.  Chambers'  Edinburgh  Journal,  January  and  February, 
1847. 

"  The  Disorders  of  Speech."     By  John  Wyllie,   Edinburgh. 

Paper  by  Conolly,  British  and  Foreign  Medico-Chirurgical  Review.  London, 
1847. 

"  De  Sindssyge  i  Norge."     Ludvig  Dahl. 

"  Causes  and  Prevention  of  Idiocy."     S.  G.  Howe,  Boston,   1848. 

"  Idiocy."     Forbes  Winslow,  London,  1848. 

"  Statistic  Studies  on  Idiocy."     Hubertz,   Copenhagen,   1851. 

"  Teaching  the  Idiot."     E.  Sidney,  London,  1854. 

"  On  the  Possibility  of  Educating  Idiot  Children."     Ehrchricht,  Copenhagen, 

1854 
"  Idiot  Training."     E.   Sidney,  London,   1855. 
"  Idiots  and  the  Efforts  for  their  Improvement."     Brockett,  Hartford,  Conn., 

1856. 
"  Reports  of  Commissioners  on  Idiocy  in  Connecticut."     Knight  and  Brockett, 

Dorchester,  1856. 
"  Handbook  of  Idiocy."    James  Abbott,  London,  1857. 
"  Essay  on  Idiot  Instruction."     Freedman  Kern,  Gohlis,   1857. 
"  Handbook  on  Idiocy."    James  Abbot,  London,   1857. 
"  Teaching  the  Idiot."     Edwin  Sidney,  London,  1857. 
"Mind  Unveiled."     I.  N.  Kerlin,  Philadelphia,  1858;  Elwyn,  1903. 
"  Two  Visits  to  Earlswood  Asylum."     E.   Sidney,  London,  1859,   1861. 
"  Bidrag  til  Kundskab  om  de  Sindssyge  i  Norge  af  Ludvig  Dahl,"  Reserve- 

laege  ved  gaustad  Sindssygeasyl,  Christiania,  1859,  p.  78. 


MENTAL   DEFECTIVES.  34I 

"  Method  of  Drill,  Gymnastic  Exercises,  etc.,  used  at  Essex  Hall,  Colchester, 
for  Idiots,  Simpletons,  and  Feeble-minded  Children."  Martin  Duncan, 
London,  1861. 

"  Essay  on  Idiocy."     Coldstream,  Edinburgh,  1862. 

"  Some  Suggestions  on  the  Principles  and  Methods  of  Elementary  Instruc- 
tion."    H.  B.  Wilbur,  Albany,  N.  Y.,   1862. 

"  Traite   Pratique  des  Maladies  Mentales."     L.   V.   Marce,   1862. 

"  Lunacy  and  Law,  Together  with  Hints  on  the  Treatment  of  Idiots."  F. 
E.  D.  Byrne,  London,  1864. 

"  The  Training  of  Idiotic  and  Feeble-minded  Children."  Cheyne  Brady, 
Dublin,  1864. 

"The  Idiot  and  his  Helpers."    W.  Millard,  Colchester,  1864. 

"  A  Fete  Day  at  Earlswood."     E.  Sidney,  London,   1864. 

"  On  Consanguineous  Marriages."  Arthur  Mitchell,  Edinburgh  Medical 
Journal,  1865. 

"  Idiot  Asylums,"  Edinburgh  Review,  July,  1865,  Vol.  CCXLIX.,  and  Littell's 
Living  Age,  1865,  Vol.  XXX. 

"  A  Manual  for  the  Classification,  Training,  and  Education  of  the  Feeble- 
minded, Imbecile,  and  Idiotic."  Duncan  and  Millard,  London,  1866,  p. 
12. 

"  Observations  on  an  Ethnic  Classification  of  Idiots."  Langdon  Down,  Clin- 
ical Lectures  and  Reports  of  the  London  Hospital,  1866,  Vol.  III.,  p.  259. 

"  Mental  Pathology  and  Therapeutics."     W.  Griesinger,  London,  1867. 

"  A  Treatise  on  Idiocy  and  its  Cognate  Affections."  J.  Langdon  Down,  Lon- 
don, 1867. 

"  Memoires  sur  les  microcephales."     Carl  Vogt,   1867. 

"Aphasia."     H.  B.  Wilbur,  Albany,  N.  Y.,  1867. 

"  Remarks  on  Sluggish  Mental  Development  Educationally  Considered."  W. 
H.  Mortimer,  London,  1868. 

"  Ueber  die  Entartung  der  Menschen."     E.  Reich,  Erlangen,  1868. 

"  Clinique  Medicale  de  l'Hotel  Dieu  de  Paris."    Vol.  II.,  Paris,  1868. 

"  The  Wow  O'Rivven."     George  McDonald,  London,  1868. 

<(  On  the  Education  of  the  Imbecile."  Dora  Greenwell,  Strahan  &  Co.,  Lon- 
don, 1869. 

"  Intermarriage  of  Relations."     Nathan  Allen,  April,   1869. 

"  Fecundity,  Fertility,  Sterility,  and  Allied  Topics."  J.  Matthews  Duncan, 
1871. 

"  Hallucinations  of  Childhood."  Proceedings  of  Connecticut  Medical  So- 
ciety, H.  M.  Knight,  May,  1872. 

'"  Broken  Gleams."     C.  Miller,  1874. 

"Heredity."     H.  Ribot,  Appleton,  1875. 

"A  Case  of  Microcephalic  Imbecility."  Shuttleworth,  Journal  of  Mental 
Science,  October,  1878. 

"Infant  Mortality,  Statistics."     T.  B.  Curtis,  New  York,   1879. 

"  Dementia :  Idiocy,  Imbecility,"  Clinical  Lectures,  MacDonald ;  New  York 
Medical  Record,  1879,  Vol.  XVL.,  pp.  577~58o. 

"  Choreic  and  Choreiform  Movements  in  Hysterical  Children."  Landon  C. 
Gray,  New  York,  1879. 


342  BIBLIOGRAPHY. 

"Idiocy  and  Imbecility  not  Insanity:  a  Definition  of  Idiocy  and  Imbecility," 
Canadian  Medical  Record,  Montreal,  Vol.  VIII.,  1879-1880,  pp.  59-65. 

"  Imbecility  Associated  with  Sclerosis."  Fletcher  Beach,  British  Medical 
Journal,  London,  1879,  Vol.  II.,  p.  815. 

"  Juvenile  Insanity."     I.  N.  Kerlin,  Philadelphia,  1879. 

"  Hints  on  Treatment  of  Paralysis  in  Early  Life."  H.  G.  Davis,  Boston 
Medical  and  Surgical  Journal,  1880. 

"  Enumeration,  Classification,  and  Causation  of  Idiocy."    I.  N.  Kerlin,  1880. 

"  Speech  in  Morbid  Affections  of  the  Mind."     Hughlings  Jackson,  1880. 

"  Visite  a  quelque  aisles  d'  alien  on  d'  idiots  de  le  Holland,"  Annales  Medical 
Psychology,  Paris,  1880,  Vol.  III.,  pp.  71-95. 

"  Insanity  in  child  five  years  old — Juvenile  Insanity."  Chatelain,  Physiolog- 
ical Medicine,  Vol.  V.,  p.  811. 

"Mental  Physiology."     W.  B.  Carpenter. 

"  The  Jukes,  Criminal  Statistics."    Dugdale. 

"  An  Essay  on  Cerebral  Affections  of  Children."  Valentine  Duke,  Hardwicke 
&  Bogue,  London. 

"  On  Epilepsy."    Gonzaliz  Echeverria. 

"  A  Treatise  on  Apoplexy,  Cerebral  Hemorrhage,  Cerebral  Embolism,  etc." 
John  A.  Liddell. 

"Treatise  on  the  Medical  jurisprudence  of  Insanity,  Idiocy,  and  Imbecility." 
John  Ray,  pp.  86-148. 

"  Trephining  Skull— 2  cases."    Glasgow  Medical  Journal,  Vol.  XIII.,  p.  243. 

"  Diseases  of  Children,"  Lecture  XVI.  Charles  West,  H.  C.  Lea,  Philadel- 
phia, Vol.  I. 

"  On  Some  Disorders  of  the  Nervous  System  in  Children."    Ibid. 

"  Hereditary  Disease."    J.  M.  Winn,  Hardwicke  &  Bogue,  London. 

"  Hereditary  Influence  (Heredity)  in  Mental  Diseases."  James  J.  O'Dea, 
Journal  of  Psychological  Medicine  and  Diseases  of  the  Nervous  System, 
January,  1870. 

"  Marriage  of  Near  Kin."    Alfred  Huth,  London,  1875. 

"  Remarks  on  the  Origin,  Varieties,  and  Termination  of  Idiocy."  George  W. 
Grabham,  1875. 

"  Kalmuc  Idiocy."  Mitchell  and  Fraser,  Journal  of  Mental  Science,  July, 
1876. 

"  Transactions  of  the  Obstetrical  Society  of  London."  December  6,  1876, 
Vol.  XVIII. 

"  Jacob  Rodrigues  Pereire,  Premier  instituteur  des  sourds-muets  en  France." 
Ernest  La  Rochelle,  F.  Dedons  et  Cie,  Paris,  1877-1881. 

"  Alcoholic  Epilepsy,"  Journal  of  Mental  Science,  January,  1881. 

"  Some  of  the  Cranial  Characteristics  of  Idiocy."  Idem,  Trans.  International 
Medical  Congress,  1881. 

"  The  Idiot ;  His  Place  in  Creation  and  His  Claims  on  Society."  Sir  Fred- 
eric Bateman,  1882. 

"  Types  of  Imbecility."  Fletcher  Beach,  Medical  Times  and  Gazette,  London, 
1882. 

"  Jacob  Rodrigues  Pereire."  Leon  Vaisse,  American  Annals  of  the  Deaf 
and  Dumb,  edited  by  Edward  Allen  Fay,  October,  1883,  Vol.  XXVIIL, 
No.  4,  p.  221. 


MENTAL   DEFECTIVES.  343 

"  An  Address  on  the  Education  of  Idiots."     George  Pycroft,  1882. 

Article  on  "  Idiocy  "  by  J.  Langdon  Down.  Dictionary  of  Medicine,  p.  68s 
By  Richard  Quain,  1883. 

"  Proceedings  of  the  Association  of  Medical  Officers  of  American  Institu- 
tions for  Idiotic  and  Feeble-Minded  Persons." 

"  The  Physical  Features  of  Idiocy."  G.  E.  Shuttleworth,  Liverpool  Med. 
Chir.  Journal,  July,  1883. 

"  The  Classification,  Training,  and  Education  of  the  Feeble-Minded,  Imbecile, 
and  Idiotic."     Charles  H.  Stanley  Davis,  1883. 

"  Is  Legal  Responsibility  Acquired  by  Educated  Imbeciles  ?  "  Journal  Men- 
tal Science,  January,  1884. 

"  The  Health  and  Development  of  Idiots  as  Compared  with  Mentally  Sound 
Children."  International  Health  Exhibition  Literature,  Vol.  XI.,  p.  526, 
London,  1884. 

"  Idiotophilus."     Sengelmann,  1885. 

"  Der  unterricht  und  die  erziehung  nicht  vollsinniger  Kinder."    Riicker,  1885. 

"  On  the  Ascribed  Causation  of  Idiocy,  as  Illustrated  in  Reports  to  the  Iowa 
Institution  for  Feeble-minded  Children."    A.  C.  Rogers. 

"  Status  of  the  Work  before  the  People  and  Legislatures,"  1886. 

"  Mental  Affections  of  Childhood  and  Youth."    J.  Langdon  Down,  1887. 

"  Weak-Minded  Children."    Journal  of  Mental  Science,  April,  1888. 

"  The  Relations  of  Marriages  of  Consanguinity  to  Mental  Unsoundness." 
Journal  of  Mental  Science,  October,  1886. 

"  A  Dictionary  of  Psychological  Medicine."  D.  Hack  Tuke,  pp.  659,  665,  805, 
1892. 

"  Elementa  Physiologica."     Haller. 

"  Zur  Aetiologie  der  Idioten."     Berlin,  1893. 

"L'  Idiotie."    Jules  Voisin,  Paris,  1893. 

"  Sengelmann's   Hand-Book  of  Idiocy."     John   Miller's   translation. 

"  The  Physiology  of  Mind."  Henry  Maudsley,  D.  Appleton  &  Co.,  1893. 

"  The  History  of  the  Treatment  of  the  Feeble-minded."  Walter  E.  Fernald, 
Boston,   1893. 

"  Psychopatische    Minderwertigkeiten    im    Kindesalter."    Triiper,    1893. 

"Dell'  Educazione  dei  Fanciulli  Frenastenici.     Gonnelli  Cioni,  1893. 

"The  Pathology  of  Mind."     Henry  Maudsley,  1894. 

"  De  quelques  formes  de  1'  hydrocephalic  (Idiotie  hydrocephalique  et  ses 
varieties)."  Par  Bourneville  et  Noir,  Recherches  Cliniques  et  Thera- 
peutiques,  Paris,  Vol.  XIV.,  pp.  I75_372,  1894. 

Journal  of  Psycho -Asthenics,  Faribault,  Minn.,  1896-1903. 

"  Mental  Affections  of  Children."    W.  W.  Ireland. 

"  Klinske  og  Aetiologiske  Studier  over  Psykiske  Udviklinsmanger  hos  Born." 
Carl  Looft,  pp.  138-180.     Bergen,  1897. 

"  Forty-sixth  Annual  Report  of  the  Managers  of  the  Syracuse  State  Institu- 
tion for  Feeble-Minded  Children."     1897. 

"Causation  and  Early  Treatment  of  Mental  Disease  in  Children."  A.  W. 
Wilmarth,  Chicago,  1894. 

"Rapport  sur  l'assistance  des  enfants  idiots  et  degeneres."     Bourneville,  1894. 

"  Mentally  Deficient  Children— Their  Treatment  and  Training."  E.  Shuttle- 
worth,  1900. 


344 


BIBLIOGRAPHY. 


"  Manuel  De  Pedagogie  Speciale."    Antonio  Gonnelli  Cioni,  p.  140,  1900. 

"  Apergu  historique  des  Institutions  en  faveur  des  sourds-muets  et  des  avew- 
gles."  Par  Emile  Gregoire,  Revue  Internationale  de  Pedagogie  Compara- 
tive, Mars,  1899,  pp.  3i~34- 

"  Studien  iiber  Klinik  und  Pathologie  der  Idiotie."     Karl  Hammarberg,  1895. 

"  Cases  of  Sporadic  Cretinism  treated  by  Thyroid  Extract."  T.  Telford 
Smith,  Journal  of  Mental  Science,  1895. 

Revue  Experimentale  de  Pheeniatrie.  Auguste  Tamburini,  Vol.  XXX.,  Fasc. 
20,  1899. 

"V  Enseignement  des  Enfants  anormaux."  Par  Th.  Secretan,  Revue  Inter- 
nationale de  Pedagogie  Comparative,  p.  195,  1899. 

Guide  to  the  Clinical  Examination  and  Treatment  of  Sick  Children.  John 
Thomson,   1898. 

"  Situation  des  Anormaux  dans  le  Grand-Duche  de  Finlande."  Par  Valter 
Forsius,  October,  1899,  p.  353. 

"  Danemark."     Par  M.  Moldenhawer,  p.  132,  Mai,  1899. 

"  Situation  de  L'  Enseignement  Relatif  Aux  Idiots  et  Aux  Arrieres  en 
Italie."     Par  Professor  Marcello  Zaglia,  June,  1900,  pp.  256-265. 

"  Ecoles  Pour  Idiots."  Par  la  baronne  Thorborg  Rappe,  April,  1900,  p. 
156. 

Manuel  de  Pedagogie  Speciale.     Par  Antonio  Gonnelli  Cioni,  1900. 

"  Responsibility  in  Mental  Diseases."     Maudsley. 

"  La  Physiologic  morbide,  dans  les  rapports  avec  la  Philosophic  de  l'His- 
toire."     Moreau  of  Tours. 

"Report  on  the  Causes  of  Idiocy  in  the  State  of  Massachusetts."     S.  Howe. 

"  Elements  of  Psychological  Medicine."     Noble. 

"  Le  Mouvement  actuel  en  Italie  pour  le  traitment  et  1'  education  des  phrenas- 
theniques."     Auguste  Tamburini. 

"  Contribution  a  1'  etude  experimentale  des  degenerations  physiques  et  mor- 
ales de  1'  homme."    Auguste  Tamburini. 

Munch,  med.  Wochenschr.;  Arch.  f.  Gyn.,  LVL,  3. 

"  Bulletins  de  la  Societe  d'  Anthropologic,"  Vol.  VI. 

"  Letters  on  the  Kindergarten."     Froebel. 

"  Indberetning  til  Kirkedepartementet  om  en  med  offentligt  stipendium  fore- 
tagen  reise  til  tyske  og  engelske  anstalter  for  sandssvage  og  epileptikere.' 
Carl  T.  Lippestad. 

Reports  of  Institutions  in  America  and  Abroad. 

"  On  Some  Slighter  Forms  of  Mental  Defect  in  Children  and  their  Treat- 
ment."   G.  E.  Shuttleworth,  British  Medical  Journal,  October  3,  1903. 

BIBLIOGRAPHY   OF   THE   SURGERY    OF   IDIOCY. 

"  On  Craniectomy  in  Microcephaly."  Victor  Horsley,  British  Medical  Jour- 
nal, September  12,  1891,  p.  579. 

"  Congres  Francais  de  Chirurgie,"  1891,  p.  80. 

"  Surgical  versus  Educational  Methods  for  the  Improvement  of  the  Mental 
Condition  of  the  Feeble-Minded."     Frank  P.  Norbury,  1892. 

"  Notes  on  Craniectomy."     G.  E.  Shuttleworth,  1892. 

"  Linear  Craniotomy  for  the  Relief  of  Idiotic  Conditions."  W.  W.  Keen, 
1892. 


EPILEPSY.  345 

"  Recherches  Cliniques  et  Therapeutiques  sur  1'  Epilepsie,  1'  Hysterie,  1'  Idiotie 
et  1'  Hydrocephalic"     Par  Bourneville,  1894. 

"  Creating  a  Mind — Stories  from  the  Diary  of  a  Doctor."  By  Clifford  Hali- 
fax and  L.  T.  Meade,  The  Strand  Magazine,  January,  1895. 

"  A  Wonderful    Surgical   Operation."     Helen   Gardener,   Harper's  Magazine. 

"The  Treatment  and  Education  of  Mentally  Feeble  Children."  Fletcher 
Beach,  1895. 

"Craniectomy  for  Idiocy  and  Imbecility."  Charles  L.  Dana,  Pediatrics, 
March  15,  1896. 

"Amaurotic  Idiocy."     Sachs,  New  York  Medical  Journal,  May  30,   1896. 

"The  Mentally  Feeble  Child  and  How  to  Train  Him."  Fletcher  Beach, 
Pediatrics,  December,  1897. 

"  Craniectomy,  with  the  After-history  of  Two  Cases."     T.  Telford  Smith. 

"  Craniectomy  for  Arrested  Mental  Development,  with  After-history  of  Three 
Cases."    J.  Moorhead  Murdock. 

"  The  Operation  of  Craniectomy."     James  C.  Carson. 

"The  Surgical  Treatment  of  Idiocy."     G.   E.   Shuttleworth. 

"The  Microcephalic  or  Idiot  Skull,  and  the  Macrocephalic  or  Hydrocephalic 
Skull."  Sir  George  Humphrey,  Scientific  Transactions  of  the  Royal 
Dublin  Society,  Vol.  V.,  Series  2. 

"  Diagnosis  and  Prognosis  of  Certain  forms  of  Imbecility."  John  Thomp- 
son, Scottish  Medical  and  Surgical  Journal,  March,  1898. 

"  The  Paralytic  Type  of  Idiocy  and  Imbecility."  T.  Telford  Smith,  Pediat- 
rics, Vol.  V,  No.  12,  1898. 

"  Idiocy  and  Imbecility."  Fletcher  Beach  and  G.  E.  Shuttleworth,  Allbutt's 
System  of  Medicine,  Vol.  VIII.,  London,  1899. 

"  Infantile  Cerebral  Degeneration  with  Symmetrical  Changes  at  the  Macula." 
E.  C.  Kingdon  and  J.  S.  Risien  Russell,  Medical  Chir.  Transactions,  Vol. 
LXXX.,  p.  86. 

"The  Brain  of  the  Microcephalic  Idiot."  D.  J.  Cunningham  and  T.  Telford- 
Smith,  Scientific  Transactions  Royal  Dublin  Society,  1895. 

"The  Vaso-Motors  in  Psychopathic  Disturbances."  Vaschide  and  Vurpas, 
Revue  de  Psychiatrie,  1903,  No.  6. 

BIBLIOGRAPHY   OF   EPILEPSY. 

"  Pronostic  et  du  Traitement  Curatif  de  I'  Epilepsie,"  Paris,  1852. 

"  Traite  de  l'Epilepsie,"  1854. 

"  Diseases  of  the  Nervous  System."     Hammond. 

"On  Epilepsy:    Anatomo- Pathological  and  Clinical  Notes,"  1870. 

Annales  Med.   Psychologique,    November,    1878;    January,    1879;    September, 

1879. 
"  De  l'Epilepsie  Consideree  dans  les  Rapports  avec  Alienation  Mentale." 
"  Epilepsy,"  Ziemssen's  Encyklopedia. 
"  Krankheiten  des  Nervenapparates,"  Virchow's  Handbuch  of  Pathologie  und 

Therapie. 
Journal  of  Mental  Science,  July,  1880;  January,  1881. 
Neurologisches  C entralblatt ,  1885. 
Le  Pr ogres  Medical,  1887. 


346  BIBLIOGRAPHY. 

"  Pathogenesis  of  Epileptic  Idiocy  and  Epileptic  Imbecility."    W.  L.  Andrie- 

zen,  British  Medical  Journal,  May  1,  1897. 
"  Les  Epilepsies  et  les  Epileptiques,"  Fere,  1890. 


A  LIST  OF  WRITINGS  BY  THE  AUTHOR. 

"  Hsematoma  Auris."    Proceedings  of  the  Association  of  Medical  Officers  of 

American  Institutions  for  Idiotic  and  Feeble-minded  Persons,  1892. 
"  Consanguinity  of  Parents  in  Relation  to  Idiocy."    Philadelphia  Polyclinic, 

March  30,  1895. 
"  The  Influence  of   Heredity  on  Idiocy."    Journal   of  Nervous  and  Mental 

Disease,  June,  1895 ;  New  England  Medical  Journal,  July,  1895. 
"  Moral   Paranoia."    Proceedings  of  the  Association   of  Medical  Officers  of 

American  Institutions  for  Idiotic  and  Feeble-minded  Persons,  1895. 
"  A  Glance  at  our  Work,  Past,  Present,  and  Future."    New  England  Medical 

Monthly,  January,  1896. 
"  Feeble- Mindedness  and  Viciousness  in  Children  an  Inheritance."    Charlotte 

Medical  Journal,  December,  1896. 
"  Some  Studies  in  Heredity."    Journal  of  Psycho- Asthenics,  September,  1896 ; 

Journal  of  Nervous  and  Mental  Disease,  March,  1897. 
"  President's    Annual    Address."    Journal   of   Psycho- Asthenics,    September, 

1897. 
"  Some   Notes   on   Echolalia,   with   the  Report  of  an   Extraordinary   Case." 

Journal  of  Nervous  and  Mental  Disease,  January,  1898. 
"Defective  Children:    Their  Needs  and  their  Rights."    International  Journal 

of  Ethics,  July,  1898. 
"  The  Training  of  Mentally  Deficient  Children."    Appleion's  Popular  Science 

Monthly,  August,  1898. 
"  Some    Diseases    Common    to    the    Feeble-Minded."    Journal    of    Psycho- 

Asthenics,  December,  1898;  Transactions  of  the  Section  on  Diseases  of 

Children  of  the  American  Medical  Association,  1898,  p.  90. 
"  The  How,  the  Why,  and  the  Wherefore  of  the  Training  of  Feeble-Minded 

Children."     Journal  of  Psycho- Asthenics,  September,   1899;  Proceedings 

of  the  National  Education  Association-,  1899;  The  State  Normal  Monthly, 

Emporia,  Kansas,  April,  1900. 
"  Adenoma  Sebaceum."    Journal  of  Psycho- Asthenics,  March,  1899. 
"  Mental   Defectives  and  the   Social   Welfare."    Appleton's  Popular  Science 

Monthly,  April,  1899. 
"  Samuel  Henderson,  Murderer :    Responsible  or  Irresponsible."    Alienist  and 

Neurologist,  January,  1900. 
Epilepsy  Modified  by  Treatment  and  Environment,  with  some  notes  of  two 

hundred  cases."    Ibid.,  January,  1900. 
"  The  Feeble-Minded :    Care  of  Them,  and  Returns  for  Amount  Expended." 

New  England  Medical  Monthly,  November,  1900. 
"A  Victory."     Youth's  Companion,  February  27,  1902. 
"  Training  a  Feeble  Mind."    Family  Herald,  London,  March,  1902. 
"  The  Recognition  and  Training  of  Mental  Defectives."    Philadelphia  Med- 
ical Journal,  March  1,  1902. 


LIST   OF   WRITINGS   BY   AUTHOR.  347 

"  Irresponsible  Classes  and  the  Community."    Ethical  Record,  July,    1902. 

"  Children  of  a  Day." 

"  State  Care  of  the  Feeble-Minded."  New  York  Medical  Journal,  July  27, 
1903. 

"  Mental  Defectives :  Their  Classification  and  Training."  Report  of  the  Pro- 
ceedings of  the  Third  International  Congress  for  the  Welfare  and  Pro- 
tection of  Children.     London,  July,  1902,  p.  252. 

Philadelphia  Medical  Journal,  August  9,  1902. 


INDEX. 


Abendberg,   37-39 

Abnormal   condition   of   mother   during 
gestation    as    a   cause   of   mental    de- 
fect, 92,  95-98 
Abortion,     attempted,     as    a    cause    of 
mental  defect,   115 
Beach    and    Shuttleworth    on, 

115 
Down   on,    115 
Howe  on,   115 
Rogers   on,    115 
Absolute    idiot,    definition    of    (Howe), 

20 
Abuse,  neglect,  exposure,  as  causes  of 
mental   defect,    119 
Rogers  on,   119 
Abuse  of   drugs  as  a  cause   of  mental 
defect,    118 
Down  on,    118 
Rogers   on,   118 
Accidents    during    birth    as    causes    of 
mental   defect,    116 
Beach    and    Shuttleworth    on, 

116 
Rogers  on,  116 
Accidents     after    birth    as     causes     of 
mental  defect,  118 
Grabham   on,    118 
Rogers  on,   118 
Actual  age,   140 

Acute    diseases    as    causes    of    mental 
defect,   117 
Rogers  on,   117 
Adenoid  growths,    180 
Adenoma   sebaceum,    179,   243—248 
and    epilepsy,    244 
cases  of,  246—248 
definition  of,   243 
description    of,    244 
diagnosis   of,   244 
location  of,   244 
pathology  of,   245 
peculiar  to   mental   defectives,   244 
prognosis   of,   244 
synonyms  of,  243 
treatment  of,  246 

Addison  on,  243 
Balzar  on,  243,   245 
Browne,  H.  C,  on,  243 


Adenoma  sebaceum,  Caspary  on,  243 
Crocker  on,   243 
Davies  on,  243 
Duhring  on,  243 
Gull   on,   243 
Hallopeau  on,  243,  246 
Jaquet  on,  243 
Makenzie  on,  243 
Pringle  on,  243,  245,  246 
Royer  on,  243 
Vidal  on,   243 
Age  of  appearance  of  epilepsy,  214 
Age,  actual,   140 

proper  to  begin  training  of  mental 

defectives,    140,    141 
psychologic,     actual     and     physio- 
logic,   140 
Albany,  experimental  school  at,  64 
Alexandria,    provision    for    mental    de- 
fectives  at,    56 
All   round   development   in   mental    de- 
fectives,   164,   165 
Alsterdorfer  institution,  42,  44 
Althaus  on  epilepsy,  214 
Amentia,  78 

American   Indians,  law  of,   24 
American  Indian  type,  83 

illustrative   cases   of,    287 
American    institutions    for    mental    de- 
fectives   (U.    S.),    77 
American  system  of  education  through 
the  hands  as  applied  to  the  training 
of  middle-grade   imbeciles,   154 
American    table    of    causes    of    mental 

defect,  94 
Amusement,   as   an   aid   in  the  physio- 
logic education  of  mental  defectives, 
134,    167-169 
Ancaster  House,   59 
Ann  of  Austria  and  the  feeble-minded, 

26 
Anoea,  78 
Antwerp,  school  for  backward  children 

at,   55 
Aosta,  attempt  at  founding  an  institu- 
tion at,  56 
Apathetic,     profound     idiot,     diagnosis 
of,   126 
superficial   idiot,   diagnosis   of,    127 
Armenia,    provision    for   mental    defec- 
tives  in,    51 


349 


35Q 


INDEX. 


Articulation,   defective,    124 
Asexualization,   189-197 

Act  of  Assembly  regarding,   195 
circular  on,  to  various  institutions 
for   mental    defectives,    192,    193 
first    step    towards    securing    legis- 
lative  action,   i93_I95 
general    observations    on,    189— 191 
methods   of  procedure  in,    197 
Everett   Flood  on,   196 
F.  Hoyt  Pilcher  on,   195,   196 
Pfister    on,    196,    197 
Asiatics,  207 

Asphyxia,  as  a  cause  of  mental  defect, 
116 
Beach   on,    116 
Down  on,   116 
Grabham   on,   116 
Ireland  on,   116 
Shuttleworth  on,   116 
Assimilation,    124 

Association    as    an    aid    in    physiologic 
education   of  mental   defectives,   134, 
166,  167 
Autenreith,  43 

Australia,   provision   for   mental   defec- 
tives in,  61 
Austria,   institutions   for  mental   defec- 
tives in,  74 
Aversion  to  companionship,   125 
Aztecs,  207 

B 

Baby  talk,    142 

Baccelli,  Signor,  minister  of  education, 

57 
Backus,  Dr.,  64 
Backwardness,   125 
Backward  children,  special  schools  for, 

7i 
Backward   or  mentally  feeble,   90 
Backward     or     feebly-gifted     children, 
diagnosis  of,   129,   130 
general  characteristics  of,  129,  130 
illustrative  cases  of,  282-286 
prognosis   of,    131 
training  of,   158,    159 
Baldovan,  school  for  mental  defectives 

at,  60 
Balzar  on  adenoma  sebaceum,  243,  245 
Barlow,   John,   on   craniectomy,    182 
Barr,    definition    of    feeble-mindedness, 
23 
discussion   of  the   classification   of 

mental  defectives,  87-89 
educational     classification     of     the 

feeble-minded,   89-90 
examples    of    heredity    of    insanity 
as    a    cause    of   mental    de- 
fect,  104 


Barr,     examples     of     intemperance     in 
parents  as  a  cause  of  men- 
tal defect,  106 
minor  neuroses  in  parents  as  a 
cause  of  mental  defect,   108 
moral    imbecility    as    a    cause 

of  mental  defect,  101 
parental    epilepsy    as    a    cause 
of  mental   defect,    107 
on    heredity    of    idiocy    and    imbe- 
cility, 92 
on  heredity  of  insanity  as  a  cause 
of  mental   defect,    104 
Barre,   Massachusetts,   63 
Bastian,    Charlton,    on   echolalia,   235 
Bateman  on  echolalia,  236 
Bath,    the    Misses    White's    school    for 

mental  defectives  at,  58 
Batz,    consanguinity    not    a    cause    of 

mental  defect  in,  no,  in 
Beach  on  asphyxia  as  a  cause  of  men- 
tal defect,   116 
on   craniectomy,   183,   185 
on  echolalia,  234 
Beach    and    Shuttleworth    on    accidents 
during  birth  as  a  cause  of  men- 
tal  defect,    116 
on   attempted   abortion   as   a  cause 

of  mental   defect,   115 
on    consanguinity    as    a    cause    of 

mental  defect,   114 
on    difficult    labor    as    a    cause    of 

mental   defect,    115 
on   febrile  illnesses  as   a  cause   of 

mental    defect,    117 
on   fright   and  mental   shock   as   a 

cause    of   mental    defect,    118 
on    heredity    of    idiocy    and    imbe- 
cility, 92 
on  heredity  of  insanity,  103 
on    infantile   paralysis   as    a    cause 

of  mental   defect,   119 
on  insolation  as  a  cause  of  mental 

defect,  119 
on     instrumental     delivery     as     a 

cause    of   mental    defect,    116 
on   minor  neuroses   as   a   cause   of 

mental   defect,   108 
on  parental  epilepsy  as  a  cause  of 
mental  defect,    107 
Bean   on  the  cure  of  epilepsy,   219 
Behier  on  echolalia,  236 
Belgium,  care  of  mental  defectives  in, 

53 
institutions    for   mental    defectives 

in,    75 
statistics   of  mental   defectives   in, 

53 
Bemiss    on    consanguinity    as    a    cause 
of  mental  defect,   in 


INDEX. 


351 


Berlin,   Municipal   Institution   in,  48 
Bertillin   on    consanguinity   as   a   cause 

of  mental  defect,   109 
Bethel,  47 
Bibliography,    338-347 

of  cretinism,   339,   340 
of  epilepsy,  345,  346 
of  mental    defectives,    340-344 
Barr,  346,  347 
Seguin,   338 
of  the  surgery  of  idiocy,   344,  345 
Bicetre,  first  organized  effort  to  benefit 

the  feeble-minded,  26-28 
Bielefeld,  45,  47 
Bishop  of  Myra,  25 
Blackstone,   definition   of   idiot,    19 
Blind  Tom,   idiot   savant,    231 
Boekel   on  craniectomy,    182 
Boerhaave,  26 

Bombeller's  visit  to  Abendberg  and  re- 
sult, 52 
Bonaterre's   observations  on  the   "  sav- 
age of  Aveyron,"  29,  30 
Bones,  brittle,   126 
Bonfigli,    M.,    on   education   for  mental 

defectives,    56,    57 
Bonnet,    Juan    Pablo,    and    deaf   mutes, 

26 
Bonsall,    Mr.    Amos,    on    consanguinity 

as   a   cause   of   mental   defect,    in 
Bost,  John,  and  his  many  institutions, 

35 
Boston,   schools  for  backward  children 

in,   71 
Bourneville     on     consanguinity     as     a 
cause    of   mental    defect,    109 
on  craniectomy,    183,    185,    186 
on  French  institutions,  35 
Brain   weight,   average,   205 
Cuvier   on,    205 
Gambetta's,   205 
Napoleon's,    205 
Sander  on,   205 
Turgenieff's,    205 
Brejning    (Jylland),   48 
Bridgman,  Laura,   122 
British  colonial   institutions,  61,   76 
Brittany,  peoples  of,  206 
Brodie,   Dr.    David,   60 
Brooke,   H.   C,   on  adenoma   sebaceum, 

243 
Brooke,  Mr.  H.  Jones,  66 
Brown  on  consanguinity  as  a  cause  of 

mental  defect,   109 
Brown's  school  at  Barre,  64 
Brussels,  school  for  backward  children 

at,  55 
Buff  on,  140 

Butterfly  disease,  179,  243-248 
Byington,  Judge,  62 


Caesar,   Julius,    an    epileptic,    219 
Calvin   on   the   feeble-minded,    26 
Canada,   institutions   for  mental   defec- 
tives in,   61 
Cancer  as  a  cause  of  mental  defect,  113 
Cape   Colony,  provision  for  mental  de- 
fectives in,  61 
Cardinal   N   — ,  hydrocephal,  209 
Cardio-vascular  system,  diseases  of,  as 

causes  of  mental  defect,   114 
Cardona  on  microcephaly,  205 
Care    of    idiot   unimprovable,    134,    135 

improvable,    135-137 
Carlbeck,    Emanuella,    49 
Carpenter,    Dr.    W.    B.,    on    shock    to 
mother   during   gestation   as    a   cause 
of  mental   defect,   96 
Caspary   on   adenoma   sebaceum,   243 
Castelli,    207 
Caribbean   tribes,   205 
Carson     on    hereditary    phthisis    as    a 
cause   of  mental   defect,    103 
on    the   heredity   of   insanity   as   a 

cause  of  mental  defect,   104 
on  parental  epilepsy  as  a  cause  of 

mental   defect,   107 
on     parental     intemperance     as     a 

cause  of  mental  defect,   106 
on  craniectomy,   188 
Causes  acting  before  birth  in  the  pro- 
duction    of    mental     defect, 
92,   95-U5 
at  birth   in   the  production  of 

mental  defect,   115,   116 
after   birth    in    the   production 
of  mental  defect,   1 16-123 
Causes  of  mental  defect : 
abuse  of  drugs,   118 
abuse,    neglect,    exposure,    119 
chorea,   119 

gastro-intestinal  diseases,  118 
hydrocephalus,    120 
infantile   paralysis,    119 
insolation,    119 
la   grippe,    119 
marasmus,    119 
masturbation,    119 
measles,    118 
spinal   diseases,    119 
tobacco,   120 
tuberculosis,    118 
typhoid   fever,    119 
whooping  cough,    119 
premature  birth,   115 
Cause  of  Mongolianism,  83 
Cazanveilh  on  epilepsy,  212 
Census  of  idiots  in  Finland,   51 
Hanover,    45 


352 


INDEX. 


Census  of  idiots  in   Pomerania,  45 
Census  of  mental  defectives  in  United 

States,   70 
Charcot  on  myxcedema,  203 
Chatter,    125 
Cheve  system,   157 
Chiavari,   school   for  mental   defectives 

at,    56 
Chicago,  schools  for  backward  children 

in,   71 
"  Children    of    the    Great    Spirit,"    25 
Christianity      and      feeble-mindedness, 

24-26 
Chorea,   180 

as   a   cause   of   mental   defect,    119 
Rogers   on,    119 
Cicero,  24 
Cigarettes  as  a  cause  of  mental  defect, 

120 
Cioccio,   206 
Circumcision,    126,    176 
Classification  of  mental  defectives,  78- 
90 
educational,   89—90 
first    (Esquirol),   79 
first  scientific   (Seguin),  79 
Barr's,   89,   90 
Down's,  J.  Langdon,   81-83 
Duncan   and   Millard's,   79,   80 
Good's,    78 
Greisinger's,    81 
Hoffbauer's,    81 
Howe's,   79 
Ireland's,  83,  84 
Kerlin's,   85,  86 
London   school   board's,    85 
Ray's,    78 

Shuttleworth's,    84,   85 
Tuke's,    Hack,    80 
Coke    (Lord),    definition    of    idiocy,    19 
Colony,    Craig,    for    epileptics    at    Son- 
yea,   N.   Y.,   65 
for    mental    defectives    in    Massa- 
chusetts,  63 
"  Colony  of  Mercy,  A,"  47 
Colonies   for   the   insane  providing   for 
mental   defectives,   55 
Gheel,    55 
Lieurneux,    55 
Columbus,   Ohio,  institution  for  mental 

defectives  at,   70 
Commission,  New  York,  64 

Report    of    the    Massachusetts,    62 
Committee,    Emilien,    57 
Genoa,   57 
Milan,   57 
Tuscan,    57,    58 
Commodus,    24 
Companionship,    aversion    to,    125 


Compulsory   school   act  of   Norway,   50 

of   Saxony,   50 
Confrerie  de   Charite,   26 
Confucius     on     care     of     the     feeble- 
minded,  25 
Connecticut  Commission,  70,  99,   100 
on   heredity   of   insanity,    104 

as    a    cause   of   mental    defect, 
106 
Conolly,  Dr.,  58,   59 
Consanguinity    as    a    cause    of    mental 
defect,    109 
Barr   on,    109 
Batz  in,  no,  in 
Beach    and    Shuttleworth    on, 

109 
Bemiss    on,    in 
Bertillin    on,    109 
Bonsall,    Amos,    on,    in 
Brown  on,  109 
Bourneville  on,  109 
Darwin,  George,  on,   no 
Down  on,   109 
Esquirol  on,  in 
Howe  on,  109,  in 
Huth,  Alfred,  on,  no 
Ireland  on,  109 
Kerlin  on,    109 
Mitchell,  Arthur,  on,  no 
Rogers  on,  109 
Tuke  on,  109 
Voisin  on,  109,  m 
Wilbur,  C.  T.,  on,  109 
Withington  on,   no 
Constantine,  Magnus,  25 
Constipation,    124 

treatment  of,    177-179 
Coordination,   lack  oi,    124 
Coprolalia    (see  echolalia),   233 
Corner,    Dr.,    cases    of    idiots    savants, 

230,   231 
Corporal  punishment,  171,  172 
Down  on,   171 
Pratt,   Mara   L.,   on,    173 
Shuttleworth  on,    171 
Cram,  protection  from,   159 
Cranial   abnormalities,    125 
Craniectomy,    182-188 

illustrative   cases    of,    290—293 

no  improvement  after  operation  in 

twelve  cases  of,   188 
report  of  cases  of,   187,  188 
sensational    literature   on,    186,    187 
Barlow   on,    182 
Beach    on,    183,    185 
Boekel   on,    182 
Bourneville   on,    183,    185,    186 
Carson  on,    188 
Cunningham    on,    183,    184 
Fuller  on,   182 


INDEX. 


353 


Craniectomy,   Horsley,  Victor,  on,   182, 
183 

Humphrey,  Sir  George,  on,  184 

Ireland,    on,    183 

Keen,   W.   W.,  on,    182,    183 

Lane  on,  182 

Lannelongue    on,    182,    183 

Murdock   on,    188 

Peau   on,    182 

Shuttleworth  on,    183,   185 

Smith,    Telford,    on,    183,    185 

Voisin  on,   188 
Creed  of  the  sensualists,   31 
Cretinism,    198-202 

bibliography   of,    339,   340 
characteristics  of,    199 
derivation   of,   198,   199 
etiology  of,  200,  201 
history   of,    36—39 
illustrative  cases  of,  293,  294 
mental   condition  in,   199 
morbid   anatomy   of,   200 
Napoleon's  plan  for  preventing  in- 
crease of,   37 
symptoms  and  diagnosis  of,   199 
synonyms    of,    198,    199 
thyroid  gland  in  treatment  of,  202 
thyroid   gland   in,    200 
treatment  and  prognosis  of,  202 

Fodere   on,    37 

Forest  on,  202 

Guggenbiihl  on,  36—39,  202 

Horsley  on,   200,   202 

Howitz,   Murray,   on,   202 

Juvenal  on,   198 

Kostl  on,  200 

Makenzie,    Hector,   on,   202 

Paracelsus  on,   198 

Plater  on,   37,  202 

Pliny  on,   198 

Schiff   on,    200,    202 

Simler   on,    202 

Strabo   on,    198 

Troxler   on,    202 

Wagner   on,    202 

Wolfgang,   Hofer,  on,   37,   202 

Wolfstein   on,   200 
Cunningham    on    craniectomy,    183,    184 
Cure  of  epilepsy,  219 
Cure   of  mental   defect,    130,    181 
Cutaneous   diseases,   126,   179 
Cuvier,  brain  weight  of,  205 


Dahl,  Ludvig,  50 

on  heredity  of  insanity  as  a  cause 
of  mental    defect,    104 
Darenth,    Metropolitan    Schools    of,    59 
Darwin,    George,    on    consanguinity    as 
a  cause  of  mental  defect,   no 


Darwin  on  the  theory  of  evolution,  205 

tubercles  of,    125 
Daumer,  Professor,  on  Kaspar  Hauser, 

121 
Davies   on   adenoma   sebaceum,   243 
Death  period  of  mental  defectives,  131, 

132 
De  Condillac,  creed  of  the  sensualists, 

Definition    of   absolute   idiot,   20 
dementia,    19 
feeble-mindedness,    23 
fool,  21 
idiot,    17-23 
imbecile,    17—23 
simpleton,    21,    22 
Defective   vision   in   mental   defectives, 

treatment  of,    176 
Dejerine  on  echolalia,  236 
Delasiauve  on  epilepsy,   212 

on     parental     intemperance     as     a 
cause   of   mental    defect,    105 
De  la  Tourette  Giles  on  echolalia,  233 
Demeaux  on  parental   intemperance  as 

a  cause  of  mental  defect,   105 
Demens,   78 

Dementia,    Esquirol   on,   20 
Ireland  on,   19 
Ray  on,   78 
Demoor,    Dr.,    55 

Denmark,    institutions    for    mental    de- 
fectives in,   72 
Deprivation,    idiocy    by,    120,    121 
Dervish  spinning,  Dr.  S.  Weir  Mitchell, 

255 
De   Sanctis,  Dr.,   56 
Descartes,   91,   206 

Diagnosis  of  backward  or  feebly-gifted 
children,   129,    130 
dullard,    128 

of  ethnological  types,  126 
of  the   idio-imbecile,    127,    128 
of  idiots  and  imbeciles,   124—130 
of  the  idiot,    126 

profound  apathetic,   126 
excitable,    126,    127 
of   the    idiot    savant,    128 

of    the    idiot    superficial    apa- 
thetic,   127 
excitable,    127 
Imbecile,  low-grade,   128 
middle-grade,    128 
high-grade,    128,    129 
mental   defectives,    124-130 
moral    imbeciles,    129 
Diarrhoea   in  mental   defectives,    124 

treatment   of,    177,    179 
Diet  of  mental   defectives,   178 
Difficult    labor    as    a    cause    of    mental 
defect,    115 


23 


354 


INDEX. 


Difficult  labor,  Beach  and  Shuttleworth 
on,   us 
Down  on,  115 
Rogers   on,    115 
Digestion    in    mental    defectives,     124, 

125 
Diphtheria   as    a   cause    of   mental    de- 
fect,  119 
Discipline    as    an    aid    in    physiologic 

education,   134,  169-173 
Diseases,    cutaneous,    in    mental    defec- 
tives, 126 
Disparity  of  age  in  parents  as  a  cause 

of  mental  defect,  120 
Disselhof,  45 
Dix,  Miss  Dorothy  L.,  66 
Dogmatic   assertion   of   any    one    cause 
of  degeneration,   impossibility  of,  91 
Donizetti,  206 
Doren,  Dr.,  70 

Down,  J.   Langdon,  on  abuse  of  drugs 

as  a  cause  of  mental  defect,  118 

on  abnormal    condition    of   mother 

during  pregnancy  as  a  cause  of 

mental  defect,  95,  96 

on  asphyxia  as  a  cause  of  mental 

defect,    1 1 6 
on  attempted   abortion    as   a   cause 

of  mental  defect,   115 
on  cancer    as    a    cause    of    mental 

defect,   113 
on  consanguinity    as    a    cause    of 

mental   defect,    109 
on  corporal   punishment,    171 
definition   of   idiocy,   22 
on  difficult    labor    as    a    cause    of 

mental    defect,    115 
on  epilepsy   as   a   cause   of   mental 

defect,   117 
on  etiology  of  microcephaly,  207 
etiological       classification       of 

mental   defectives,   81 
ethnological     or     physiognom- 
ical  classification   of  mental 
defectives,  82,  83 
on  heredity  as   a  cause   of  mental 
defect,    99 
of  insanity  as  a  cause  of  men- 
tal   defect,    104 
of  phthisis  as  a  cause  of  men- 
tal  defect,    102 
on    hydrocephalus    as    a    cause    of 

mental   defect,    120 
on   idiots    savants,    229,   230 
on    infantile    paralysis    as    a    cause 

of  mental  defect,  119 
on  injuries  to  the  head  as  a  cause 

of  mental  defect,   117 
on  insolation  as  a  cause  of  mental 
defect,   119 


Down,     J.     Langdon,     on    instrumental 
delivery    as    a    cause    of    mental 
defect,   116 
on    masturbation    as    a    cause    of 

mental   defect,    119 
on  meningitis  as  a  cause  of  mental 

defect,    118 
on  parental  epilepsy  as  a  cause  of 
mental  defect,  107 
intemperance    as    a    cause    of 

mental  defect,  104 
minor  neuroses  as  a  cause  of 
mental    defect,    108 
Down,   Reginald   Langdon,   234 
Dramatic  instinct  in  mental  defectives, 

168,   169 
Drooling,    125 

Dugdale,  Richard,  "  The  Jukes,"   102 
Duhring,  on  adenoma  sebaceum,  243 
Dullard,   128,   146 
"  Dummy   chuckers,"   216 
Duncan    and    Millard,    classification    of 

mental   defectives,    79,   80 
Dunphey,  Mrs.  M.   C,  64 
Durloo,  48 

E 

Earliest  recorded  training  of  the  idiot 

in  America,   36 
Earlswood,   59 
Ears,  care  of,   177,   178 
degenerate,   125 
diseases  of  the,  180 
Ebberodgaard,  48 
Echolalia,    234—242 
case  of,  236 

Kirtie  M — ,  237-242 
combination    with     coprolalia    and 

palmus,  233,  237 
definition    of,    233 
derivation   of,   233 
diagrammatical       explanation       of, 

234-236 
frequency   of,  233 
transcortical    motor    aphasia,    234, 

235 
Bastian,    Charlton,   on,   235 
Bateman  on,  236 
Beach  on,  234 
Behier  on,   236 
Dejerine  on,  236 
Down,   Reginald  Langdon,   on, 

234 
Echeverria  on,  233 
Gray,   Landon   Carter,  on,  233 
Ireland  on,  234 
Lichtheim  on,  234,  235,  241 
Lombroso  on,  234 
Mills    on,   236 
Noir  on,   233 


INDEX. 


355 


Echolalia,  Romberg  on,  233 

Shuttleworth   on,  234 
Spiller,  W.  G.,  on,  234,  241 
Tourette,   Giles  de  la,  on,  233 
Tuke  on,  234 
Echophrasia,  233 

Educational  classification  of  the  feeble- 
minded   (Barr),    89,    90 
Education  of  idiots  (Ettmiiller),  41,  42 
Edward   II,    law   enacted   during   reign 

of,  25,  26 
Ego,  the   abnormal,    125 
Egyptians,   207 
Elagabalus,   24 

Elam,    Dr.,    on    parental    intemperance 
as  a  cause  of  mental  defect,  104,  105 
Elwyn,   Dr.   Alfred,   65 
Emesis,   124 
Emile,  26,  28 
Emilien   Committee,   57 
English  schools  for  feeble-minded  chil- 
dren, 76 
English  table  of  causes  of  mental  de- 
fect, 93 
Enuresis,  treatment  of,  177 
Environment  as   an   aid  in   physiologic 

education,    134,   165,   166 
Epilepsy,   211—227 

acute  sickness   as  a  cause  of,   214 
adenoma  sebaceum   and,   244 
age   of  appearance  of,   214 
articles  of  food  to  be  avoided  in, 

227 
aurse,    218 

table  of,  217 
bibliography  of,   345,   346 
Bielefeld,  cure  of  in,  219,  226 
care   during   an   attack   of,    223 
Craig    Colony,     cure     of    in,     219, 

226 
definition   of,   211 
dentition  as  a  cause  of,  214 
diagnosis   of,   214-217 
dietary  in,  222,   224,   226,   227 
environment   and,   222,   224,   225 
etiology  of,  211— 214 
example  of  longevity  in,  220 
exciting  causes   of,   220 
exercise  of  will  power  in  prevent- 
ing, 221 
focal,    illustrative    cases    of,    311, 

312 
grand   mal,   214,   215 
heredity  in,   212,   214 
history   of,   211 
hystero,    217 

illustrative   cases   of,   309-313 
immunity  from,  212 
infantile     convulsions     and,     212, 
214 


Epilepsy,  injury  to  mother  during  ges- 
tation as  a  cause  of,  214 
intemperance  of  parents  as  a  cause 

of,  213 
Jacksonian,   214,   216 
life  period  in,   220 
marriage  laws  and,  225,  226 
nocturnal  treatment  of,  224 
noted  epileptics,  218,  219 
occupations    for    those    subject    to, 

221,   222 
parental  as  a  cause  of  mental  de- 
fect,   106 

Barr  on,  107 

Beach    and    Shuttleworth    on, 
107 

Carson  on,   107 

Down  on,   107 

Echeverria  on,   107 

Fere  on,    107 

Gowers  on,   107 

Kerlin   on,    107 

Rogers   on,    107 
pathology  of,  217,  218 
periodicity  of,  219,  220 
petit  mal,  214,  215 
premonitory    symptoms    of    an    at- 
tack of,  217 
prognosis  of,  218,  219 
psychical,  214,  215 
reappearance  of,  212,  219 
sex  predisposition  to,  213,  214 
status   epilepticus,   215,   218,   224 
surgical  treatment  of,  224 
symptomatic   classification    of,    214 
syphilis   in  parents   as  a  cause  of, 

213 
table  of  age,  sex  and  cause  of,  214 
traumatism  as  a  cause  of,   213 
treatment   of,    221—224 

Althaus   on,   214 

Bean   on,    219 

Boucher   on,    212 

Boyd  on,  214 

Cazanveilh  on,  212 

Delaisauve  on,  212 

Echeverria  on,   212,   213 

Fleschig   on,    224 

Gowers  on,  213,  217,  218 

Gray,  Landon  Carter,  on,  213, 
214 

Hamilton   on,   213 

Hammond  on,   212 

Hasse   on,    213 

Herpin  on,  212,  213 

Hippocrates    on,    211 

Maissonneuve  on,   219 

Marie  on,   213 

Martin  on,  212,  213 

Moeli   on,   213 


356 


INDEX. 


Epilepsy,    treatment   of,    Nothnagel    on, 

213 
Osier  on,   213,  214 
Reynolds   on,   213 
Sieveking  on,   213 
Spratling  on,  213 
Trousseau   on,   219 
Weiss  on,  215,  216 
Epileptics,    colony    for,    at    Sonyea,    N. 

Y.,  65 
Erethism,    125 

Etiological   classification  of  mental  de- 
fectives, 81,   82 
Etiology,  American  table,  94 
Etiology,    discussion   on   American   and 
English   tables,   92,   95 
English  table,  93 
of  mental  defectives,  91—123 
similarity     in     preponderating     in- 
fluences  in   English   and  Ameri- 
can tables,   93 
therapeutics     and — of    idiocy     (M. 
Schenker  of  d'  Aaran),  52,  53 
Ethnological    or   physiognomical    classi- 
fication of  mental  defectives, 82, 83 
types,  diagnosis  of,  126 
Ettrmiller    on    the    education    of   idiots, 

41,   42 
Eunuchs,   191,  192 
Europe,  peoples  of  northern,  206 
Esquirol,    classification    of    mental    de- 
fectives, 79 
on    consanguinity    as    a    cause    of 

mental  defect,   111 
definition  of  idiot,   19,   20 
on   dementia,   20 

on    relation   between    size   of   head 
and  intelligence,  204 
Essex  Hall,  Colchester,  59 
Euphrasia,   25 

Examples    of    children    with    imbecile 
parents,    106 
of   insane   heredity   as   a   cause   of 

mental   defect    (Barr),    104 
of  minor  neuroses  in  parents  as  a 
cause   of   mental    defect    (Barr), 
108 
of  moral   imbecility  as  a  cause  of 

mental   defect,    101 
of   syphilis   in   parents   as   a   cause 
of  mental   defect,    114,    115 
Excitable  profound  idiot,  126 

superficial    idiot,    127 
Experimental  school  at  Albany,  N.  Y., 

64 
Explanation   of  grades,    138 
Exposure,   abuse,   neglect   as   causes   of 
mental   defect,    119 
Rogers   on,   119 


Falret,  33 
Fatua,   24 

Febrile    illnesses    as    causes    of    mental 
defect,  117 
Beach    and    Shuttleworth    on, 
117 
Feebly-gifted     or     backward     children, 
129-131,    158,   159 
diagnosis   of,   129,   130 
general  characteristics  of,  129,  130 
prognosis   of,    131 
training  of,   158,   159 
Feeble-mindedness,      definition     of 

(Barr),  23 
Fere    on   parental    epilepsy   as   a   cause 

of  mental  defect,  107 
Ferrus,  28,  33 

Fevers,     ephemeral     in     mental     defec- 
tives, 179 
Fingers,   clubbed,    125 
Finland,  institutions   for  feeble-minded 

children   in,    74 
First   attempt   at   any    form    of   mental 
training     for     feeble-minded     in 
Germany   (Guggenmoos),  37 
idiot  asylum  in  Sweden,  49 
organized     effort     to     benefit     the 

feeble-minded    (Bicetre),   26 
private     institution      in      Germany 

(Kern),  42 
school    for   defectives   in   America, 
62,   63 
England,   58 
Italy,    56 
Scotland,   60 
Fleschig  on  the  treatment  of  epilepsy, 

224 
Flightiness,   125 
Flood,    Dr.   Everett,    on   asexualization, 

196 
Focal  epilepsy,  illustrative  case  of,  311, 

312 
Fodere  on  cretinism,   37 
Fontenay   (de),  Saboureux,  28 
Fool,  definition  of   (Howe),  21 
Fools  of  the  middle  ages,  25 
Forest  on  cretinism,  202 
Foul  breath,   125 

France,    institutions    for   mental    defec- 
tives in,  71 
Franklin,  asymmetrical  development  of 

intellectual    power,    231 
Free    play    in    the    training    of    mental 

defectives,  160 
French  institutions,  an  observation  on, 

35 
Fright  or  mental  shock  as  a  cause  of 
mental  defect,  118 


INDEX. 


357 


Fright  or  mental  shock  as  a  cause  of 
mental  defect,  Beach  and 
Shuttleworth   on,    118 

Froebel's  methods  especially  adapted 
to   mental   defectives,    140 

Fuller  on  craniectomy,   182 


Gait,   125 

Gall,    on    minimum    circumference    of 

skull  in  microcephaly,  204 
Gambetta,   brain  weight  of,  205 
Gamle  Bakkehus,  48 
Garrison    family,    70,    71 
Gaskell,  Mr.,  58 

Gastro-intestinal  diseases  as  a  cause  of 
mental   defect,    118 
Rogers   on,    118 
Gauge   of   motor  power   as   a  basis   of 

classification,   80 
Geasche,  42 

General    characteristics    of    mental    de- 
fectives, 126—130 
backward  or  feebly-gifted  children, 

129,   130 
dullard,    128 
idiot,    126 

profound   apathetic,    126 

excitable,   126 
superficial  apathetic,   127 
excitable,   127 
idio-imbecile,    127,    128 
idiots  savants,   128 
imbecile,   high-grade,   128,   129 
low-grade,    128 
middle-grade,    128 
moral   imbecile,   129 
General    notes    on   training   mental    de- 
fectives,  138—140 
Genius    of    Earlswood    (idiot    savant), 

230 
Genitalia   of  idiots  and  imbeciles,   126, 

176 
Genoa,   committee,   57 
Georgens  and  his   schools,   52 
Germany,    institutions    for    mental    de- 
fectives in,   71,   72 
Gheel,   colony   for   insane   at,   55 
Giacomini  on  theory  of  evolution,   205 
Grabham    on    accidents    as    a   cause   of 
mental   defect,    118 
asphyxia    as    a    cause    of    mental 

defect,   116 
consanguinity  as  a  cause  of  mental 

defect,   109 
epilepsy  as   a  cause  of  mental  de- 
fect,  117 


Grabham    on    heredity    as    a    cause    of 
mental  defect,  99 
hereditary   phthisis    as   a   cause   of 

mental   defect,    102 
hydrocephalus  as  a  cause  of  men- 
tal defect,   120 
instrumental    delivery    as    a    cause 

of  mental   defect,    116 
masturbation  as  a  cause  of  mental 

defect,    119 
parental    intemperance    as    a   cause 

of  mental   defect,    106 
syphilis    in   parents   as   a   cause   of 
mental  defect,  114 
Grades,   explanation   of,    138 
Grahamstown  asylum,  Cape  Colony,  61 
Grand   mal,    illustrative   cases    of,    309, 

310 
Grandoni,  Antonia,  205,  206 
Gratiolet   on  theory   of   evolution,   204, 

205 
Gratz   asylum   and  hospital   for  mental 

defectives,    52 
Gray,  Landon  Carter,  on  echolalia,  233 

on  epilepsy,  213,  214 
Greece,  provision  for  mental  defectives 

in,  51 
Griesinger,  43 

on    abnormal    condition   of   mother 
during   gestation    as   a   cause   of 
mental  defect,  95 
on   classification    of   mental    defec- 
tives, 81 
Grofstrom,  Theol.  F.,  49 
Gladbach,   on  idiotic   children  with  in- 
temperate parents,   106 
Glasell,  49 
Goethe,    asymmetrical    development    of 

intellectual  power,  231 
Goitre  as  a  cause  of  mental  defect,  113 
Gonnelli-Cioni,  Antonio,  56 
Good,    his    classification   of   mental   de- 
fectives,   78 
Gowers  on  epilepsy,  213,  217,  218 

on  parental  epilepsy  as  a  cause  of 
mental   defect,    107 
Guggenbuhl's     appeal     to     the     Vienna 
academy  of  sciences,   52 
work   among    the    cretins    of    Swit- 
zerland,  36—39 
Guggenmoos  on  mental  training  of  the 

idiot,   37 
Guislain,    Ghent,    hospital    for    the    in- 
sane,  54,  55 
Gull,    Sir    William,    on    adenoma    seba- 
ceum, 243 
on   myxcedema,   203 
Gums,    125 

Gymnastics    in   the  training   of   mental 
defectives,   160-163 


358 


INDEX. 


Haldenwang,  Pastor,  37,  43 

Haller,  26 

Hallopeau   on   adenoma  sebaceum,  243, 

246 
Hamilton  on  epilepsy,  213 
Hammond  on  epilepsy,  212 
Hands,  the,   125 

Hand  training,  first  steps  in,  for  mid- 
dle-grade imbeciles,   150 
Hanson,  50 

Hasse  on  epilepsy,  213 
Hauser,  Kaspar,   121,   122 
Hauy,  Valentine,  and  the  blind,  28 
Hearing  imperfect,   124,  125 
Heart    diseases    in    mental    defectives, 

179 
Hedman,   Edwin,  51 
Helferich,  43 
Helsingfors,  51 

Hemorrhoids  in  mental  defectives,   180 
Henderson,  Samuel,  case  of,  314-326 
Hereditary  phthisis  as  a  cause  of  men- 
tal defect,  102 
Carson  on,  103 
Down   on,   102 
Grabham   on,    102 
Kerlin    on,    103 
Piper  on,  103 
Rogers  on,  103 
Heredity  a  law,  123 
Heredity,  Down  on,  99 
Grabham  on,  99 
Illinois  State  Board  of  Chari- 
ties Report  of — on,   100 
Ireland  on,  99 
Kerlin  on,  99 

Massachusetts  commission  on, 
99 
State    Board   of    Charities 
Report  of — on,  99 
Rogers  on,  99 

Scottish    Lunacy    Commission 
on,  99 
examples  of,  98 

of  idiocy  and  imbecility  as  a  cause 
of  mental  defect,  92 
Barr  on,  99 

Beach  and  Shuttleworth  on,  92 
of   insanity   as   a   cause   of   mental 
defect,  103 
Beach    and    Shuttleworth    on, 

103 
Carson  on,  104 
Connecticut     Commission     on, 

104 
Dahl,  Ludvig,  on,  104 
Down    on,    104 
Kerlin  on,  104 


Heredity  of  insanity,   Koch  on,   103 
Rogers  on,  104 
of  moral  imbecility,    100 

examples  of,  101 
reversional,   ior 
Herpin  on  epilepsy,  212,  213 
High-grade     imbeciles'      school     work, 

outline  of,   17s 
Hofer,  Wolfgang,  on  cretinism,  37 
Hoffbauer's     classification     of     mental 

defectives,  81 
Holland,    provision    for    mental    defec- 
tives in,  51,  52 
list  of  institutions  for  mental   de- 
fectives in,  74 
Hornig,   42 
Horsley  on  cretinism,  200,  202 

on  myxcedema,  203 
Horsley,   Victor,    on    craniectomy,    182, 

183 
Howe,    abnormal    condition    of   mother 
during  gestation  a  cause  of  men- 
tal  defect,   95 
attempted     abortion     a     cause     of 

mental  defect,  115 
case  of  idiot  savant,   231 
classification   of  mental  defectives, 

79 
consanguinity  as  a  cause  of  men- 
tal defect,  109 
definition  of  absolute  idiot,  20 
definition  of  fool,  21 
idiot,  20—22 
imbecile,   20 
simpleton,   20—22 
first    attempt    to    train     idiots    in 

America,    36,    62 
heredity  of  insanity  as  a  cause  of 

mental   defect,   104 
parental    intemperance   as    a   cause 

of  mental  defect,  105 
scrofula  as  a  cause  of  mental  de- 
fect,  113 
Howitz,   Murray,  202 
Hubertusburg,   42 
Htibertz,  J.   R.,  48 
Humphrey,  Sir  George,  on  craniectomy, 

184 
Hungary,    condition    of    mental    defec- 
tives  in,   52 
Hunt,   Governor,  64 
Huth,   Alfred,    no 
Hydrocephalus,   208-210 

as  a  cause  of  mental  defect,  120 
Down  on,   120 
Grabham  on,  120 
Rogers  on,  120 
definition  of,  208 
derivation  of,  208 
etiology   of,   209 


INDEX. 


359 


Hydrocephalus,    general    characteristics 
of,  209 
illustrative  cases   of,   300,   301 
internal,  208 
external,   208 
prognosis  of,  209 
treatment    of,    210 

Tuke,  Hack  on,  210 
Cardinal  N  — ,  case  of,  209 


Idiocy,  bibliography  of  the  surgery  of, 

344,  345 
caused   by   minor   neuroses   in    pa- 
rents,  108 
by   deprivation,    120,    121 
by  isolation,   121,    122 
Ray  on,  78 
Idio-imbecile,  general  characteristics  of 
the,    127,    128 
illustrative   cases  of,   254,   255 
training  of,    137,    138 
Idiot,  definition  of,  17-23 
Barr,   23 
Blackstone,   19 
Coke   (Lord),   19 
Down,  22 
Esquirol,  19,  20 
Howe,  20—22 
Ireland,  19,  22 
Legal,  19 
Maudsley,    22,   23 
Ray,   22 
Roman,  19 
Seguin,    20 
Shakespeare,    19 
Wilbur,   22 
derivation   of,    18 
diagnosis  of  the,   124-130 
general   characteristics   of  the,   126 
profound  apathetic,  126 
excitable,    126,    127 
superficial  apathetic,   127 
excitable,    127 
improvable,   care  of,   135-137 
illustrative    cases    of,   249-254 

profound    apathetic    unimprov- 
able,  249 
excitable        unimprovable, 
249-251 
superficial     apathetic     improv- 
able, 251,  252 
excitable   improvable,  252- 
254 
population  of  Hanover,  45 
of  Ireland,    126 
of  Italy,  56 
of   Pomerania,   45 


Idiot,  prognosis  of  the,   130 

synonyms  of,   17 

unimprovable,  care  of,  134,  135 
Idiot   savant,   228—231 

Blind  Tom,  231 

definition  of,  228 

general  characteristics  of  the,  128, 

157 
illustrative  cases  of,  301-305 
Katzen-Raphael,  231 
Mind,   Gottfried,   231 
physiology  of,  228 
Quenan,   229 

Corner,  Dr.,  on,  230,  231 
Down  on,  229,  230 
Howe  on,   231 
Maudsley  on,   230 
Peterson   on,   228 
Illegitimacy  as   a   cause  of  mental   de- 
fect,   120 
Arthur  Mitchell  on,  120 
Illinois,  schools  for  backward  children 
in,   71 
State    Board    of    Public    Charities 
on  heredity,   100 
Imbecile,  definitions  of,  17—23 
definition  of  Barr,  23 
Howe,   20 
Ireland,   19 
Maudsley,   22 
Spitzka,    19 
derivation   of,    18 
synonyms  of,   17 
Imbeciles,    high-grade,    general    charac- 
teristics   of,    128,    129 
illustrative    cases    of,    260—263 
training    in    the    manual    and 
intellectual  arts  of,   154-158 
in    music,    156—158 
low-grade,     general    characteristics 
of,    128 
illustrative   cases   of,   256,   257 
middle-grade,   American  system   of 
education  through  the  hands 
as  applied  to,   154 
first    steps    in    hand    training, 

150 
general  characteristics  of,   128 
industrial  occupation  for,   144, 

145 
how  taught  numbers,   148-150 
reading,    146—148 
writing,    146—148 
illustrative    cases    of,    257-259 
paper  sloyd  and,  153 
sloyd  and,  152,  153 
Imbeciles    by    deprivation,     illustrative 

cases  of,  286,  287 
Imbeciles,    moral,    general    characteris- 
tics of,   129 


360 


INDEX. 


Imbeciles,  high-grade,  illustrative  cases 
of,  275-281 
low-grade,     illustrative     cases     of, 

264—266 
middle-grade,   268—275 
Imbecility,    diagnosis   of,    124-130 
prognosis  of,   130,   131 
Ray  on,   78 
Imbecillis,   78 
Incest,  112 

as  a  cause  of  mental  defect,  112 
Inconstantia,    78 
Indians,  North  American,  206 
Indian  type,   North  American,  illustra- 
tive case  of,  287 
Inertia,  general,   125 
Infantile  paralysis  as  a  cause  of  men- 
tal defect,    119 
in  mental  defectives,   140,  141 
Influence  of  an  idiot  upon  an  imbecile, 

167 
Ingels,  Dr.,  55 

Injuries  to  head  as  a  cause  of  mental 
defect,   116,   117 
Down  on,   117 
Rogers  on,   117 
Innocents,  17,  25 
Insanity,  231,   232 

definition    of,    231 
diagnosis  of,  232 
etiology  of,  232 
illustrative  cases  of,   305-308 
intercurrent,   among   mental   defec- 
tives,  231 
melancholia  and,   232 
prognosis  of,  232 
symptoms    of,    232 
treatment  of,   232 
Ray   on,    78 
Insolation  as  a  cause  of  mental  defect, 
119 
Beach    and    Shuttleworth    on, 

119 
Down  on,    119 
Instinct    of    justice    in    mental    defec- 
tives, 169 
Instrumental    delivery    as    a    cause    of 
mental  defect,   116 
Beach    and    Shuttleworth    on, 

116 
Down  on,  116 
Grabham  on,   116 
Rogers   on,    116 
Intemperance  of  parents  as  a  cause  of 
epilepsy,   213 
as  a  cause  of  mental   de- 
fect, 104 
American   table,    104 
English   table,    104 
Barr  on,    106 


Intemperance    of    parents,    Carson    on, 
106 
Connecticut     commission     on, 

106 
Dahl  on,   105 
Delasiauve  on,    105 
Demeaux   on,    106 
Down   on,   104 
Elam   on,    104,   105 
Grabham   on,    106 
Howe    on,    105 
Ireland  on,    105 
Kerlin   on,    106 
Kind  on,   105 
Looft  on,  105 
Rogers  on,    105 
Voisin   on,    105 
Wilbur,    C.   T.,   on,    105 
Ireland,   institutions    for   feeble-minded 

in,  76 
Ireland,  as  superintendent  at  Larberth, 
60 
of    Mavisbush    House,    60 
asphyxia  as  a  cause  of  mental  de- 
fect,  116 
classification  of  mental   defectives, 

83,  84  _ 
consanguinity  as  a  cause  of  mental 

defect,   109 
craniectomy,    183 
definition  of  idiot,   19,  22 

of   imbecility,    19 
dementia,   19 
echolalia,  234 
heredity,    99 
parental    intemperance    as    a   cause 

of  mental   defect,    104,   105 
scrofula  as  a  cause  of  mental  de- 
fect,  113 
syphilis   as  a  cause   of  mental   de- 
fect,   114 
Ishii   (Osuga),  Mr.  R.,  of  Tokyo,  61 
on   shock  to   mothers  during  preg- 
nancy as  a  cause  of  mental   de- 
fect,  96 
Italy,  founding  of  first  school  at  Chia- 
vari    in,    56 
institutions    for    mental    defectives 
in,-  75 
Itard  and  the  savage  of  Aveyron,  28 
on   physiologic   education,    30 
program    of    the    training    of    the 
savage   of  Aveyron,   31 


Jacksonian    epilepsy,    illustrative    cases 

of,  311,   312 
Japan,  provision   for  mental   defectives 

in,  61,   76 


INDEX. 


361 


Jastrowitz  on  inflammation  of  the  brain 
in   utero    as   a   cause    of   mental    de- 
fect, 118 
Jacquet  on  adenoma  sebaceum,  243 
Jovill  on  relation  between  size  of  head 

and  amount  of  intelligence,  204 
"Jukes,  The,"  Richard  Dugdale,   102 
Justice,    instinct    in    mental    defectives 

of,    169 
Jutland,  institution  for  idiotic  children 
in,  72 


Kalmuck  or  Mongolian  type,  83 
Karens   Minde,   48 

Katzen,   Raphael    (idiot  savant),   231 
Keen,  W.  W.,  on  craniectomy,  182,  183 
Kelbs    on    etiology    of    microcephalus, 

207 
Keller,  Helen,   122 
Keller  institutions,  48 
Kerlin,    Dr.    Isaac    N.,    and   the    Penn- 
sylvania Training  School,  67-69 
on   abnormal    condition    of   mother 
during   gestation    as   a    cause   of 
mental   defect,   96 
classification  of  mental   defectives, 

85,  86 
consanguinity  as   a  cause  of  men- 
tal  defect,   109 
hereditary   phthisis   as    a   cause   of 

mental   defect,    103 
heredity,   99 

of  insanity  as  a  cause  of  men- 
tal defect,   104 
parental    epilepsy    as    a    cause    of 
mental    defect,    107 
intemperance    as    a    cause    of 

mental  defect,  106 
minor  neuroses  as  a  cause  of 
mental  defect,  108 
syphilis   in   parents   as   a   cause   of 
mental   defect,    114 
Kern,  36,  42,  45 
Kirtie,    M — ,    case    of    echolalia,    237, 

242 
Kew  Asylum,  Melbourne,  for  insane,  60 
Kind,  45 
Kindergarten,  outline  of  work  in,   173, 

174 
Kjellberg,   49 

Knight,  Dr.   Henry  M.,  70 
Koch    on    heredity    of    insanity    as    a 

cause  of  mental  defect,  103 
Kohl,   37 

Konishi,    Mr.    (Tokyo),    61 
Koran  on  consanguinity  as  a  cause  of 

mental   defect,    112 

on    the   care   of   feeble-minded,    25 
Kostl  on  cretinism,  200 


Kraft-Rail,  43 
Kuckenmiihle,  45 


La  Force,   35 

La  grippe  as  a  cause  of  mental  defect, 

119 
Lakeville,    Connecticut,    institution    at, 

70 
La  Maison  St.  Benoit,  Lokeren  institu- 
tion, 54 
Lane  on  craniectomy,  182 
Langenhangen,  45 

Lannelongue   on  craniectomy,   182,    183 
Larbert,   Sterlingshire,  60 
Larema,  78 

La  Rochelle,   Ernest,  27 
Last  born,  theory  that  they  are  apt  to 

be   Mongolians,   83 
Laughter,   125 
Law  of  heredity,   123 
Laws  of  American  Indians,  25 
Edward  II,  25,  26 
Lycurgus,  24 
Rome,  24 

South  Sea  islanders,  24 
Sparta,  24 
Laws  on   idiocy,   24 

marriage    (Connecticut),    189,    190 
M.    Schenker  of  d'   Aaran,  52 
Legal  definition  of  idiot,  19 
Leibnitz,  206 
L'Epee,   Abbe   de,   30 
Les  enfants  du  bon  Dieu,  17,  25 
Letchworth,   Wm.  P.,   65 
Levana,    52 

Lichtheim  on  echolalia,  234,  235,  241 
Lierneux,  colony  for  the  insane,  55 
Liesing,   52 
Life    limit    of    mental    defectives,    131, 

132 
Lightning   calculators,    228 
Lillemosegaard,  48 
Limit  of  life  of  mental  defectives,  131, 

132 
Linnaeus,     eleven     wild     children     de- 
scribed by,   29,    30 
Lippestad,  50 
Lips,   125 
Lisping,   143 
Locke,  34 

Lohe,  Johannes  C.  W.,  46 
Lombroso  on   echolalia,  234 
theory  of  evolution,  205 
London    school   board    classification    of 

mental    defectives,    85 
Looft,    Carl,    on   parental   intemperance 

as  a  cause  of  mental  defect,   105 
Low-grade    imbecile,    training    of,    144, 

146 


362 


INDEX. 


Low-grade  school  work,  outline  of,  174 
Lycurgus,  24 

M 

Macaulay,     asymmetrical     development 

of  intellectual  power,  231 
MacKenzie,    Hector,   on   cretinism,   202 
Mahommed  an  epileptic,  219 
Maisonneuve   on   the   cure   of   epilepsy, 

219 
Makenzie    on    adenoma    sebaceum,    243 
Malay  type,   83 
Manage  in  Hainault,  asylum  for  idiots 

and  epileptics  at,  53 
Mania  (Ray),  78 

Manual  occupations   for   low-grade   im- 
beciles,   144,    145 
training     for     middle-grade     imbe- 
ciles,  151-154 
Marasmus  as  a  cause  of  mental  defect, 

119 
Marce,  examples  of  parental  intemper- 
ance   as    a    cause    of    mental    defect, 
106 
Mariaberg,   42,   43 
Marie  on  epilepsy,  213 
Marois,  Mile.,  28 

Marriage    laws,    Connecticut,    189,    190 
in  regard  to   epileptics,   225,   226 
M.  Schenker  of  d'  Aaran  on,  53 
Martin  on  epilepsy,  212,   213 
Massachusetts,    colony    for    mental    de- 
fectives   in,    63 
commission,  report  of,  62 

on  heredity,  99 
first  school  in  America  for  idiotic 
and    feeble-minded    children    in, 
62,  63 
schools   for  backward   children   in, 

9i 
State  Board  of  Public  Charities  on 
heredity,  99 
Mastication,   125 

Masturbation  as  a  cause  of  mental  de- 
fect, 119 
Down   on,   119 
Grabham  on,   119 
Rogers  on,  119 
Maudsley,  definitions  of  idiocy  and  im- 
becility,  22,   23 
on  idiots  savants,  230 
Mavishbush  House,  Polton,  60 
McCulloch,   Oscar   G.,    "The   Tribe   of 

Ishmael,"    101 
Measles   as   a   cause   of   mental   defect, 
119 
Rogers  on,   119 
Memory,   phenomenal,    126 
Meningitis  as  a  cause  of  mental  defect, 
118 


Meningitis    as    a    cause    of   mental    de- 
fect, Down  on,  118 
Rogers  on,    118 
Jastrowitz  on,  118 
in  mental   defectives,   180 
Menstrual  derangements,  180 
Mental  defect,  definitions  of,  17-23 
Mental      defectives,      bibliography      of, 
338-347 
classification  of,  78—90 
life  limit  of,    131,  132 
outline     of    physiologic     education 

of,    133,    134 
provision   for  in   Armenia,   51 
Greece,  51 
Holland,    51 
Milan,  56 
Turkey,    5 1 
training   of,    133-175 
treatment  of,    175-181 
Mental      defectiveness,      diagnosis      of, 
124-130 
etiology  of,  91—123 
prognosis  of,   130,   131 
Mentally   feeble   or  backward,   90 
Mental    training    for    middle-grade    im- 
beciles,   1 46-1 5 1 
Microcephalus,  204-208 
age  limit   in,  208 
artificial   as   practiced   among   Asi- 
atics, 207 
Aztecs,  207 

Brittany,  peoples  of,  206 
Caribbeans,  207 
Egyptians,  207 
in  Rome,  207 

North   American   Indians,   206 
North  Europe,  peoples  of,  206 
Peruvians,  206 
diagnosis  of,  208 
etiology  of,  207 
Down  on,   207 
Kelbs   on,   207 
general  characteristics  of,  208 
illustrative    cases   of,    295-300 
prognosis    of    (Shuttleworth),    208 
brain    weight,    average,    205 
relation  to,   205 

Cardona  on,  205 

Castelli  on,  207 

Sanders    on,   205 

Waldemyer  on,   206 

of  Cioccio,   206 

of  Cuvier,  205 

of  Gambetta,  205 

of       Grandoni,      Antonia, 

205,  206 
of  Napoleon,  205 
of  Tourgenieff,  205 
Descartes,    206 


INDEX. 


563 


Microcephalics,  relation  to  brain  weight, 
Donizetti,   206 
Shelley,   206 
Leibnitz,    206 
minimum       circumference       of 
skull   and   intellect,   204 
Gall  on,  204 
Voisin  on,  204 
relation  between  size   of  head 
and    degree    of    intelli- 
gence, 204 
Esquirol   on,   204 
Jovill  on,  204 
Pritchard   on,   204 
theory   of   evolution,   204,    205 
Down  on,  205 
Giacomini,    205 
Gratiolet,  204 
Lombroso,  205 
Middle-grade   school    work,    outline   of, 

174,    175 
Milan,  committee,  51 

provision  for  mental  defectives  in, 
56 
Military   drill   as   a  means   of   develop- 
ment   of    high-grade    imbeciles,    157, 
161,   162 
Millard    and    Duncan,    classification    of 

mental  defectives,  79,  80 
Mills  on   echolalia,   236,   237 
Millville,  N.  J.,  school  for  mental   de- 
fectives at,   71 
Mind,   Gottfried,   idiot  savant,  231 
Mirror  writers,  228 

Mitchell,    Arthur,    on    consanguinity   as 
a  cause  of  mental  defect,   no 
on  illegitimacy  as  a  cause  of  men- 
tal   defect,    120 
Mitchell,    Dr.    S.    Weir,    rotary    move- 
ments, 255 
Modes  of  discipline,   169-173 
Moeli   on   epilepsy,   213 
Moira,  78 

Mongolianism,   cause  of,   83 
Mongolian  or  Kalmuck  type,  83 

illustrative   cases   of,   288,   289 
Montessori,  Signorina,  and  work  of  the 

national  league,    57 
Moral   imbeciles,    illustrative    cases    of, 
264—281 
high-grade,   275-281 
low-grade,  264—266 
middle-grade,    266-275 
Moral  imbecility  as  a  cause  of  mental 
defect,  100 
diagnosis  of,   129 
characteristics  of,   129 
examples  of,  as  a  cause  of  mental 

defect    (Barr),    ior 
general  characteristics  of,  129 
prognosis  of,    131 


Moral    training    of    mental    defectives, 

164,    165 
Morel,  Dr.,  55 
Morgagni,  26 

Morselli  and  his  school,   56    ' 
Mothers     during     gestation,     abnormal 
condition   of — as    a   cause   of   mental 
defect,  92,  95-98 
Mouth,  degenerate,  125 
treatment    of,    177 
Murdoch  on  craniectomy,   188 
Musical  phenomena,  228 
Music   as   a   means   of   development   of 

high-grade  imbeciles,    156-158 
Muscular  coordination  in  mental  defec- 
tives,   162—164 
movements,  reflex,  125 
Myxcedema,   203 

definition  of,  203 
history   of,   203 

illustrative   cases  of,   294,   295 
morbid  anatomy  of,  203 
prognosis   of,  203 
symptoms  of,  203 
thyroid  treatment  of,  203 
Charcot   on,   203 
.    Gull   on,   203 

Horsley,   Sir  William,  on,  203 
Ord  on,  203 
Virchow  on,  203 


N 

Nails,  125 

Napoleon  an  epileptic,  218 
brain  weight   of,   205 
proposed  method  of  reducing  cre- 
tinism   in    Switzerland,    37 
National  League  of  Italy,  57 
Neglect,   exposure   and   abuse   as   cause 
of  mental  defect,   119 
Rogers   on,   119 
Negroes,  207 

Negroid  type,  illustrative  cases  of,  287 
Nero,  24 

Nervi,   school  at,   56 
Nervous   diseases,   180 
Nervous  signs,  124 
Neuralgia,    180 

Neuroses,  minor,  in  parents  as  a  cause 
of  mental   defect,    108 
Barr  on,   108 
Beach    and    Shuttleworth    on, 

108 
Down  on,   108 
Kerlin   on,    108 
Rogers  on,  108 
Newark,    N.    Y.,    State    Custodial   Asy- 
lum, 64 
Neudorfer,  43 
Neuendettelsau,  46 


364 


INDEX. 


New  York  Commission,  64 

Craig   Colony    for    epileptics,    Son- 
yea,  65 
provision  for  mental  defectives  in, 

64 
schools   for  backward   children,   71 
State    Custodial    Asylum,    Newark, 

64 

Rome,  64,  65 
Noir,  on  echolalia,  213 
Normandy,  peoples  of,  206 
Normansfield,  59 
Norway,  institutions  for  feeble-minded 

children  in,   71 
Norwegian  institutions,  51 
Nose,  degenerate,   125 
Nothnagel,  213 
Numbers,   how   taught   to    imbeciles   of 

middle   grade,    148-150 


Occupation,  industrial  and  manual,  for 
low-grade   imbeciles,    144,   145 

Odor,    125 

Ogilvy,  Sir  John  and  Lady  Jane,  60 

Ohio,  provision  for  mental  defectives 
in,  70 

Old  age  in  parents  as  cause  of  Mon- 
golianism,  83 

Orange,  N.  J.,  70 

Ord,   on  myxcedema,   203 

Organs  of  generation  in  mental  defec- 
tives, treatment   of,    176 

Orillia,  Canada,  60 

Osier  on  epilepsy,  213,  214 

Outline  of  kindergarten  work  for  men- 
tal defectives,   173 


Paget,  shock  to  mother  during  gesta- 
tion as  a  cause  of  mental  defect,  96 

Palate,   degenerate,   125 

Palmus,  233 

Paper  sloyd  for  middle-grade  imbe- 
ciles,   1  S3 

Park   House,   Highgate,   58 

Parrish,  Dr.  Joseph,  and  his  connec- 
tion with  the  Pennsylvania  Training 
School,   66 

Pathologic  classification  of  mental  de- 
fectives,   83,    84 

Peau  on   craniectomy,    182 

Pennsylvania,  provision  for  mental  de- 
fectives  in,    65—70 

Percy,  Baron,  shock  to  mothers  during 
gestation  as  a  cause  of  mental  de- 
fect, 96 

Pereire,  Jacob  Rodrigues,  the  exponent 
of   physiologic    education,    27,    28,    30 


Peruvians,   206 
Peterson,  Dr.  Frederick,  65 
Peterson   on   idiots   savants,   228 
Petit  mal,  illustrative  cases  of,  310,  311 
Peto,    Sir    Samuel    Morton,    and    Essex 

Hall,  59 
Pfister  on  asexualization,   196,  197 
Philadelphia,      schools     for     backward 

children  in,  71 
Phonetic    exercises    for    mental    defec- 
tives, 142 
Phrenica,  78 

Phthisis,  hereditary,  as  a  cause  of  men- 
tal defect,   104 
as    a   cause    of   Mongolianism, 

83 
Physical   exercises   as   a  means   of  de- 
velopment   for   high-grade    imbeciles, 
157-161 
Physiognomical    or   ethnological   classi- 
fication  of  mental   defectives,  82,  83 
Physiologic  education  (Pereire),  27,  30 
age  in,  140 

amusement    as    an    aid    in,    134 
association  as   an   aid  in,    134 
discipline   as    an   aid   in,    134 
environment  as   an   aid  in,   134 
outline   of,    for   mental    defectives, 

133,  134 
Pilcher,    F.     Hoyt,    on    asexualization, 

195,    196 
Pinel,   31 
Piper,     on     hereditary     phthisis     as     a 

cause   of  mental   defect,    103 
Plater,    Felix,   on   cretinism,    37,   202 
Platz,   Friederich,   51 
Polk,  Pa.,  institution  for  feeble-minded 

children   at,   69,   70 
Polsingen,   45,   46 
Poole,    Dr.    Richard,    on   education,   59, 

60 
Pope    Pius    IX    acknowledges    Seguin's 

book,   33 
Potter,  Bishop  Alonzo,  65,  66 
Prague,  asylum  at,  52 
Precocity,   125 
Premature  birth  as  a  cause  of  mental 

defect,   115 
Pringle    on    adenoma    sebaceum,     243, 

245,  246 
Pritchard,     relation     between     size     of 

head     and     amount     of    intelligence, 

204 
Profound     apathetic     idiocy,     diagnosis 
of,  126 
excitable  idiocy,   diagnosis   of,    126 
Prognosis  of  feebly-gifted  or  backward 
children,    131 
of  idiot,    130 
of  imbecile,    130,    131 


INDEX. 


365 


Prognosis  of  mental  defectives,  130,  131 
of  moral   imbeciles,    131 

Prolonged  infancy  in  mental  defec- 
tives,   140,    141 

Providence,  R.  I.,  schools  for  back- 
ward children  in,  71 

Psychic    epilepsy,   illustrative   cases   of' 

312,  313 
Psychologic   age,    140 
Punishment,  corporal,   171,   172 

Down   on,    171 

Pratt,   Mara   L.,   on,    173 

Shuttleworth  on,    171 

Q 

Quenan,   idiot   savant,   229 

K, 

Randall's   Island  Asylum,   64 
Ray,  classification  of  mental  defectives, 
78 
definition   of   idiot,    22 
Rayer  on  adenoma  sebaceum,  243 
Reading,    how    taught    to    middle-grade 

imbeciles,    146—148 
Receptivity  of  mental  defectives,  141 
Reed,   36 

Reed,    Rev.    Andrew,    impetus    to    the 
work    among    mental     defectives     in 
England,  58,  59 
Reflex  muscular  movements,  125 
Reggio-Emilia,  56 
Reversional  heredity,   101 
Reves,  Hainault,  institution  for  mental 

defectives  at,   54 
Reynolds  on  epilepsy,  213 
Rheumatism,   179 
Rhode    Island,    schools    for    backward 

children  in,   71 
Ribot  on  heredity,  97 
Richards,  James   B.,   opens  first  school 
in  Pennsylvania  at  Germantown, 
65 
sent    to    Paris    to    study    Seguin's 
methods    of    training    the    idiot, 
62 
Riga,  Si 

Rogers      on      abnormal      condition      of 
mother    during    gestation    as    a 
cause    of   mental    defect,    96 
abuse  of  drugs  as  a  cause  of  men- 
tal defect,    118 
abuse,  neglect,  exposure  as  a  cause 

of  mental  defect,   119 
accidents    as    a    cause    of    mental 

defect,    118 
accidents   during  birth   as  a   cause 
of  mental  defect,   116 


Rogers  on  acute  diseases  as  a  cause  of 
mental  defect,  118 
attempted   abortion   as   a   cause   of 

mental   defect,   115 
cancer    as    a   cause    of   mental    de- 
fect,  113 
chorea   as    a   cause   of   mental    de- 
fect,  119 
consanguinity  as  a  cause  of  mental 

defect,    109 
difficult  labor  as  a  cause  of  mental 

defect,  115 
diphtheria    as    a    cause    of    mental 

defect,    119 
epilepsy  as   a  cause  of  mental  de- 
fect, 117 
gastro-intestinal      diseases      as      a 

cause  of  mental  defect,   118 
heredity,  99 
hereditary   phthisis    as   a   cause   of 

mental  defect,  103 
hydrocephalus  as  a  cause  of  men- 
tal defect,   120 
infantile   paralysis    as    a    cause    of 

mental  defect,  119 
injuries  to  head  as  a  cause  of  men- 
tal   defect,    117 
insanity  as  a  cause  of  mental  de- 
fect,  104 
instrumental    delivery    as    a    cause 

of   mental   defect,    116 
masturbation  as  a  cause  of  mental 

defect,    119 
measles   as   a  cause   of  mental   de- 
fect,  119 
meningitis    as    a    cause    of    mental 

defect,    118 
parental    epilepsy    as    a    cause    of 
mental    defect,    107 
intemperance    as    a    cause    of 

mental   defect,    105 
neuroses,  minor,  as  a  cause  of 
mental   defect,    108 
premature  birth  as  a  cause  of  men- 
tal defect,   115 
scarlatina    as    a    cause    of    mental 

defect,    118 
scrofula  as  a  cause  of  mental  de- 
fect,  113 
spinal  diseases  as  a  cause  of  men- 
tal  defect,   119 
typhoid   fever  as   a  cause  of  men- 
tal  defect,   119 
whooping    cough    as    a    cause    of 
mental   defect,   119 
Roman  definition  of  mental  defectives, 

19 
law,  24 
Romberg  on  echolalia,  233 
Rome,  56,  207 


366 


INDEX. 


Rome,  N.   Y.,  State   Custodial  Asylum 
at,  64,  65 

Rosch,  43 

Rotary  movements,  Dr.  S.  Weir  Mitch- 
ell, 255 

Rothenburg,  45,  48 

Rousseau,  an  epileptic,  218 

Rousseau,    Jean    Jacques,    attack    upon 
old  systems,   26,   27 

Royal  Albert  Asylum,  59 

Royghen,    Ghent,   provision   for   mental 
defectives  in,   55 

Ruez    on    parental    intemperance    as    a 
cause  of  mental  defect,   105 

Russian   institutions,    51 

for  feeble-minded  children,  74 


Saegert's  attempt  at  training  the  idiot, 

36,  40 
Saint  -  John  -  Persiceto,      medico  -  peda- 
gogic school  of,  57,  58 
Salthre,  J.,  50 

Sander  on  brain  weights,  205 
Savage  of  Aveyron,  the,  28—31 
Scarlatina  as  a  cause  of  mental  defect, 
118 
Rogers   on,   118 
Schenker,  M.  of  d'  Aaran,  etiology  and 

therapeutics   of   idiocy,    52,   53 
Schiff  on  cretinism,  200,  202 
Schmidt,  P.,  of  Gratz,  52 
School  act  of  Norway,  compulsory,   50 
of   Saxony,   compulsory,    50 
work  for  high-grade  imbeciles,  out- 
line of,  175 
low-grade     imbeciles,     outline 

of,   174 
middle-grade     imbeciles,     out- 
line of,   174,   175 
Schuman,  206 
Scotland,  institutions  for  feeble-minded 

children,   76 
Scott,  asymmetrical  development  of  in- 
tellectual power,  231 
Scottish   Lunacy   Commission,   99 

national    institution    for    defective 
children,  60 
Scrofula  as   a  cause  of  mental   defect, 

113 

Howe   on,    113 

Ireland    on,    113 

Rogers   on,    113 
Secretions,  odor  of,   125 
Segatelli,   Signora,   and   her  school,    56 
Seneca,   24 

Sengelmann  on  Guggenbuhl,  39,  40 

Seguin,    a   list   of   his   writings,    338 

and   mental    defectives,    28 


Seguin  and  the  school  at  Bicetre,  33 
book  acknowledged   by   Pope   Pius 

IX,  33 
connection   with   the    Pennsylvania 

Training  School,  66 
definition  of  idiot,  20 
first      scientific      classification      of 

mental  defectives,   79 
private   school   in    Paris,    33 
results    of   experiment,   physiologic 

and  psychologic,    34 
school     for    mental    defectives     at 
Orange,  N.  J.,   70 
Sensorists,  30 
Sensualists,   30 
Sex    predisposition    to     epilepsy,     213, 

214 
Sexual    desires     of    idiots    and    imbe- 
ciles,   126 
Shakespeare,    definition    of    idiot,    19 
Shelley,    206 

Shock,    mental,    as   a   cause   of   mental 
defect,   118 
Beach    and    Shuttleworth,    118 
Shuttleworth    and    Beach    on    accidents 
during  birth  as  a  cause  of  men- 
tal   defect,    116 
on  attempted   abortion   as   a   cause 

of  mental  defect,  115 
on  consanguinity    as    a    cause    of 

mental  defect,  109 
on  difficult    labor    as    a    cause    of 

mental  defect,  115 
on   febrile   illnesses   as   a  cause  of 

mental   defect,   117 
on   fright   or   shock   as   a  cause  of 

mental  defect,    118 
on    heredity    of    idiocy    and    imbe- 
cility,   92 
of  insanity  as  a  cause  of  men- 
tal  defect,   103,    104 
on    infantile   paralysis    as    a    cause 

of   mental   defect,    119 
on  insolation  as  a  cause  of  mental 

defect,    119 
on     instrumental     delivery     as     a 

cause   of   mental    defect,    116 
on    minor   neuroses    in   parents    as 

a  cause  of  mental  defect,   108 
.on  parental  epilepsy  as  a  cause  of 

mental   defect,   107 
on   syphilis   in  parents   as  a  cause 
of  mental   defect,    114 
Shuttleworth  on  asphyxia  as  a  cause  of 
mental   defect,    116 
classification   of  mental  defectives, 

84,  85 
corporal  punishment,   171 
craniectomy,    183,    185 
echolalia,  234 


INDEX. 


367 


Shuttleworth    on    prognosis    of    micro- 

cephalus,   208 
Sialorrhcea,    125 
Sicard,   Abbe,   30 
Sienna,   56 

Sieveking   on    epilepsy,    213 
Sight,   imperfect,    125 
Simler,   202 
Simpleton,    definition    of    (Howe),    20- 

22 
Skin,  125 
Skofde,  49 
Skoptzies,    191 
Slavering,    124,    125 
Sloyd  for  middle-grade  imbeciles,    152, 

iS3_ 
Solitaires,    79 
South  Sea  Islanders,  24 
Spartan  law,  24 
Speech   defect,   test  words   in,    143 

defective   treatment   in   mental   de- 
fectives,  176 
imperfect,    124 

in   mental   defectives,    141,    142 
method  of  teaching  to   mental   de- 
fectives,   142—144 
Spiller,   William   G.,   on   echolalia,   234, 

241 
Spinal    diseases   as   a   cause    of   mental 
defect,    1 1 9 
Rogers  on,   119 
Spitzka's   definition   of   imbecility,    19 
Spongy   gums,   treatment  of,    177 
Sports  as  an  aid  in  training  mental  de- 
fectives,  159 
Spratling  on   epilepsy,  213 
Stammering,    143,    144 
Starcross,  59 

Statistics  of  mental  defectives  in  Bel- 
gium, 53 
Stetten,  45,  46 
Stephanie    Asylum    at    Biedermansdorf, 

52 
Stewart    Institution,    Palmerston,    Dub- 
lin,  60 
St.   Ferdinand,   Belgium,  institution   at, 

54 
Stigmata   of   degeneration,    125 
cranial    abnormalities,    125 
ears,   125 
gums,   125 
hands,    125 
lips,    125 
mouth,    125 
nose,   125 
palate,   125 
skin,   125 
teeth,    125 
tongue,    125 
St.  Nicholas,  25 


Stories  of  the  children,  327-337 
St.    Paul,    25 

an   epileptic,   219 
Stultitia,  78 
Stupiditas,   78 
St.     Vincent     de     Paul's     care    of    the 

feeble-minded,   26 
Sulliness,   125 
Sumner,  George,  62 

Superficial    idiot,    apathetic,     diagnosis 
of,   127 
excitable,    diagnosis   of,    127 
Surgery    of   idiocy   and   imbecility,   bib- 
liography of  the,  344,   345 
Sweden,   institutions   for   feeble-minded 

children  in,  73 
Swedish   Ling   system,    161 
Switzerland     institutions     for     feeble- 
minded, 74,  75 
for   mental    defectives,    52,    53 
Synonyms   of  feeble-mindedness,    17 
Syphilis,   parental,    as   a    cause    of   epi- 
lepsy,  213 
as    a   cause   of   mental    defect, 

114 
Down  on,  114 
Grabham   on,    114 
Ireland   on,    114 
Kerlin   on,    114 
Shuttleworth    and    Beach    on, 

114 
Thompson,  John,   on,   114 
examples   of,   114,   115 
Syracuse,    N.   Y.,   institution   at,   64 


Tabor,  46 

Tamburini,   Professor,  57 
Taylor,  Franklin,  65. 
Teeth,   125 

treatment  of,  177 
Telford-Smith,   183,   185 
Tessenderloo,   Limbourg,   asylum  of,  53 
Test  words  in  speech  defect,   143 
Theodosius,   25 
Theory  of  the  sensualists   (sensorists), 

30 
Theroid   idiots,  the,   81 
Thomson,  John,  on  parental  syphilis  as 

a  cause  of  mental  defect,   114 
Thorshaug,  50 
Throat    diseases    in    mental    defectives, 

179 
Tobacco,  use  of,  as  a  cause  of  mental 

defect,  120 
Tongue,  125 
Tonic  Sol-fa,  157 

Training  of  backward  and  feebly-gifted 
children,    158,    159 
idio-imbeciles,   137,   138 


;68 


INDEX. 


Training    of    idiot    in    Germany    (Sae- 
gert),  36 
imbeciles,    144-158 

high-grade,    154-158 
low-grade,    144-146 
middle-grade,    146-154 
mental  defectives,   133,  175 

general  notes  on,   138-140 
moral    of    mental    defectives,    164, 

165 
Traumatism  as  a  cause  of  epilepsy,  213 
Treatment    of   mental    defectives,    175— 

181 
"  Tribe    of    Ishmael,    The,"    (Oscar    G. 

McCulloch),    101 
Trousseau  on  the  cure  of  epilepsy,  219 
Troxler,  202 

Tubercles  of  Darwin,   125 
Tuberculosis  as  a  cause  of  mental  de- 
fect, 118 
tendency   to    in   mental   defectives, 
178,    179 
Tuke,  Hack,  on  classification  of  mental 
defectives,  80 
consanguinity  as  a  cause  of  mental 

defect,  109 
echolalia,  234 
hydrocephalus,    208,    209 
Turgenieff,  brain  weight  of,  205 
Turkey,  provision  for  mental  defectives 

in,    51 
Tuscan  committee,  57,   58 

school  at  Settignano,  58 
Twining,  Dr.  William,  58 
Tycho,  Brahe,  25 

Typhoid    fever    as    a    cause    of   mental 
defect,  119 
Rogers   on,    119 


U 

Ulcers,    179 
Ullersvedsvien,  50 

United     States,     America,     institutions 
for  mental  defectives  in,  tj 


Vision,  defective  treatment  of  in  men- 
tal  defectives,    176 
Voisin  on  consanguinity  as  a  cause  of 
mental   defect,    109,    no,    in 
craniectomy,  188 
minimum     circumference    of    skull 

with  intelligence,  204 
parental    intemperance    as    a    cause 
of  mental  defect,   105 

W 

Wagner   on    cretinism,    202 
Waldemyer,  206 
Wanderlust,    170 
Weiss  on  epilepsy,  215,  216 
White  Doves,  191 

White,  the  Misses,  first  school  for  men- 
tal defectives  in  England,  58 
Whooping  cough  as  a  cause  of  mental 

defect,    119 
Wilbur,    C.    T.,   on   consanguinity   as   a 
cause  of  mental  defect,    109 
on     parental     intemperance     as     a 
cause  of  mental  defect,   105 
Wilbur,  Hervey  B.,  definition  of  idiocy, 
22 
discussion      of      classification      of 

mental   defectives,   86,   87 
primary    cause    of    mental    defect, 
96 
Wild    children    described    by    Linnaeus, 

29,   30 
Winchester   House,   59 
Withington     on     consanguinity     as     a 

cause  of  mental  defect,   no 
Wolfstein  on  cretinism,  200 
Writing,    how    taught    to    imbeciles    of 

middle  grade,  146—148 
Writings  of  E.   Seguin,  a  list  of,  338 
Wyllie,    Dr.,    on   stammering,    143,    144 


Yahn,  Gustave,  46 
Ybbs,  school  at,  52 


Vercurago,  first  school  for  mental  de- 
fect in  Italy  at,  56 

Vidal  on  adenoma  sebaceum,  243 

Vineland.  N.  J.,  institution  for  feeble- 
minded  children   at,    71 

Virchow  on  myxoedema,  203 


Zimmer,  43 

Zion  institutions,  47 

Zola's  Les  Rougous-Macquart,  exam- 
ples of  transmission  of  neuroses, 
107,  108 

Zoroaster,  on  care  of  the  feeble- 
minded, 25 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE   BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE   DUE 

AUG 

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"    "     '    u 

.: 

- 

NC 

V  2  51946 

T| 

^f  9     1951 

t 

C2BI1  140)  Ml  00 

B27 


